Covid-19 (Drug and Alcohol Services, and Homelessness): Statements

I call the Minister of State, Deputy Feighan, who will share time with the Minister of State, Deputy Butler.

I thank the Leas-Cheann Comhairle, I welcome this opportunity to update the House on drug and alcohol services and health supports for people who are homeless during the Covid-19 pandemic.

Not everyone faces the same risk from Covid-19. People who use drugs or alcohol in a problematic way are at heightened risk due to underlying health and social factors. These are compounded for people who are homeless, who experience multiple morbidity and are at risk of premature death. There can also be risks associated with the consumption of illicit drugs or large quantities of alcohol. In particular, the ageing cohort of opioid users are vulnerable to Covid-19 because of a high level of pre-existing health problems and lifestyle factors. It is estimated that 19,000 people with opioid dependency and 4,500 single people are homeless, with a significant overlap between these two groups. The Department of Health and the HSE have prioritised these groups in our response to Covid-19.

The incidence of Covid-19 among people living with addiction and in homelessness has remained low during the third wave of the pandemic. Health Protection Surveillance Centre, HPSC, data for the period from late-November to mid-February show that, in addiction services, there have been nine outbreaks of Covid-19 involving 48 cases. Of these cases, three people have been hospitalised and, unfortunately, one person has died, which is most regrettable. In homeless services, there have been a further nine outbreaks involving 41 cases. Of these, two people have been hospitalised. These figures include staff in homeless services. By comparison, there were 3,076 outbreaks of Covid-19 nationally, while in residential institutions there were 186 outbreaks with 1,308 associated cases.

It is clear from the data that the impact of Covid-19 on people in addiction or homelessness has been much less than expected. This low incidence has been achieved by the actions of health and social care services, which prioritised these groups in terms of protection, detection and case management. These services are saving lives, perhaps not in hospitals, but by ensuring that people with underlying health conditions do not end up in intensive care in the first place.

What have we done during Covid-19 to achieve this positive outcome? What are the lessons we can draw for health policy? I wish to highlight three positive lessons. First, we have seen significant improvements in HSE addiction services during Covid-19. Specific measures were developed to ensure that all people in receipt of opioid substitution treatment could continue safely on the treatment during the pandemic, and that anyone who required opioid substitution treatment would receive it. Not alone did the existing 10,000 patients continue in opioid substitution treatment throughout the pandemic, but an additional 900 people were brought into treatment in the past year, an increase of more than 8%. Many of these new recruits have chaotic lives, including up to 100 who are rough sleepers or homeless.

Additional supplies of naloxone were also provided during Covid-19 to minimise the risk of drug overdose, and an awareness campaign was put in place in conjunction with the Union for Improved Services, Communication and Education, UISCE, the voluntary organisation representing service users. The Department of Health is providing an additional €4.2 million in 2021 to retain the specific actions taken to support increased access to opioid substitution treatment during Covid-19. I am delighted the gains that have been achieved in the crisis are now being mainstreamed within the HSE health services.

Second, I highlight the exceptional measures put in place to protect and support homeless people. The HSE appointed a dedicated team, including a clinical lead, to co-ordinate the Covid-19 homeless response for the large cohort of single homeless people in Dublin. The purpose of the team is to intensify the health supports provided to homeless people during Covid-19. I will share some headline figures from the team. A total 282 medically vulnerable homeless individuals are being supported in shielding facilities. A further 1,000 homeless service users in private temporary accommodation are receiving significant health supports. Sixty-five Covid-positive homeless users are in self-isolation facilities with another 105 service users who are suspect or close contact cases. Fifty-two staff members in homeless services who are Covid-positive have been supported since December, and up to 100 rough sleepers and homeless people have been put on opioid substitution treatment, OST.

In July last year, l, together with the Minister, Deputy Donnelly, met with the Minister for Housing, Local Government and Heritage to agree how dedicated funding and resources could be provided to deliver the necessary health and mental health supports required to assist homeless people with complex needs. I have made the health needs of homeless persons a key priority. The HSE winter plan is the first step in increasing funding for targeted health interventions for people who are homeless and in addiction. The Department of Health provided an additional funding of €5.5 million to meet the following objectives: continue the protective help measures for the medically vulnerable homeless population; expand GP services for people living in emergency accommodation in Dublin and regional centres; and provide continuity of care for homeless people requiring emergency hospital treatment. In budget 2021, the Government provided €11 million to extend these measures for the full year.

Further initiatives to meet the health needs of homeless people are also being funded, including a specialist mental health outreach team. More resources are only one component of the policy response, however. The other element is a co-ordinated approach to the complex health and social needs of homeless people between the HSE, the Dublin Region Homeless Executive, DRHE, and voluntary homeless and drug and alcohol services.

The third lesson I wish to highlight is the development of a long-term and sustainable response to chronic homelessness and rough sleeping. The Department of Health and the Department of Housing, Local Government and Heritage have prioritised a housing-led approach, with a vision of housing together with integrated wrap-around health and tenancy supports to assist people in maintaining a tenancy and improving physical and mental health. Since the start of the pandemic, additional Housing First tenancies have been established for individuals who had been sleeping rough or had been long-term users of emergency accommodation. A total of 208 tenancies were established in 2020. I am informed that altogether, 1,006 single persons exited emergency accommodation into homes in 2020 in the Dublin region. The Department of Health has provided an additional €1.125 million to provide health supports for 218 new tenancies under the Housing First programme in 2021. This will help achieve the national target for Housing First of 663 tenancies to be delivered by the end of the year.

The need for drug and alcohol services extends across the population. Problem drug and alcohol use is a societal issue that continues during a pandemic and, in some circumstances, can get worse as people struggle with lockdown. To better understand the impact of Covid-19 on drug and alcohol services, the Department of Health undertook a rapid assessment, involving an online survey of services, case studies and analysis of European data on drug use. The initial findings of this assessment were presented to the national oversight committee for the national drugs strategy, which I chair. They highlight how drug and alcohol services have been curtailed but have adapted to new ways of working to continue to support people affected by substance misuse.

As part of the Government plan for living with Covid-19, the Department of Health has developed a framework to support the restoration and continuation of drug and alcohol services in a planned and appropriate manner in line with public health advice.

Officials worked with drug and alcohol service providers to identify the guidance and supports needed. To support these essential services, I approved additional funding of €480,000. I recognise the vital role played by the drug and alcohol support groups and treatment programmes in reducing the harm of substance abuse and in supporting rehabilitation.

I advocate a targeted campaign to reach vulnerable groups that otherwise may not have equal access to the vaccine. Listening to and engaging with vulnerable groups are critical to building confidence in the Covid-19 vaccination programme. This will take time, resources, targeted communications and innovative delivery mechanisms. In particular, a collaborative approach to roll out the vaccine with the HSE addiction and inclusion health services, section 39 organisations and service users is required. While considering the vaccine allocation strategy for vulnerable groups, we must be aware that this is contingent on the supply of the vaccine into the country.

Covid-19 has brought into focus the health inequalities faced by people who are homeless and in addiction. I hope that Deputies have an understanding of the measures we have put in place to protect these groups, not just from Covid-19, but to enhance their health status on a long-term basis. The experience of Covid-19 has reinforced the need to treat drug and alcohol misuse as a public health issue. The national drug strategy, Reducing Harm, Supporting Recovery, provides the roadmap to a health-led approach to drug and alcohol misuse. I am overseeing a mid-term review of the strategy, which builds on the many innovative measures developed during Covid-19. I look forward to hearing the contributions of Deputies on these matters.

I thank Members for allowing me time today to highlight the specific actions being taken to address the mental health needs of people experiencing homelessness and of individuals with a dual diagnosis of addiction and mental health difficulties. Covid-19 has posed significant challenges across society, including increased stress, anxiety and fear, not least for these particular groups of individuals. It is well evidenced that homelessness can be both a cause and a consequence of mental health problems. Similarly, drug and alcohol misuse frequently co-exist with mental health difficulties.

Sharing the Vision, our new national mental health policy, recognises that both individuals experiencing homelessness and people with a dual diagnosis should have access to appropriate mental health services and supports by addressing existing service gaps and developing stepped, integrated models of care. With respect to dual diagnosis, the policy is transformative in that it reverses a problematic policy recommendation set out in A Vision for Change in 2006. For individuals with a dual diagnosis, it will no longer be necessary to establish whether a mental health difficulty is the primary issue to access the support of a community mental health team. On this basis, the policy recommends a tiered model of integrated service provision for people with a dual diagnosis to ensure clear care pathways and improved outcomes for individuals and their families.

The work of the national implementation and monitoring committee on Sharing the Vision is progressing since its establishment late last year. The committee is tasked with driving and overseeing implementation of the policy’s recommendations, including those relating to dual diagnosis and homelessness. Of the additional €50 million allocated to mental health in budget 2021, €23 million is dedicated to commencing implementation of many of the short-term recommendations in Sharing the Vision. This includes the expansion of the clinical care programme for dual diagnosis. To date, a draft model of care for dual diagnosis has been developed, based on international best practice and the experience of the national working group. It takes account of service user views and describes the clinical care pathway for individuals, with integration across primary care, substance misuse, community mental health and acute services. Significant progress has been made on the recruitment of a national clinical lead and programme manager for dual diagnosis. Successful applicants have been identified for both posts and have accepted the roles. Start dates are being negotiated. Once these two key posts are in place, a multidisciplinary steering working group will be established to finalise the model of care and will identify pilot sites to commence the programme.

Mental health development funding will also be available this year to enhance specialist mental health services for people who are homeless. This includes the appointment of a consultant in the north Dublin homeless mental health service following recent approval of the post. Similar plans are in place for the south Dublin homeless mental health service. There are two specialist community mental health teams in Dublin for people who are homeless and experiencing severe or complex mental health issues. People experiencing homelessness can also access general community mental health teams and mental health supports within the primary care sector. A range of dedicated mental health supports for people who are homeless are also delivered through HSE-funded community and voluntary groups, including Safetynet, Merchants Quay Ireland and Dublin Simon Community. More broadly, mental health services and supports will be improved through Sharing the Vision implementation structures for people experiencing homelessness across a broad continuum of supports. This includes mental health promotion, prevention, primary intervention and specialist mental health assertive outreach teams in addition to housing, education and employment supports to enhance social inclusion and recovery.

It is essential that a cross-sectoral approach is taken, including between social inclusion and mental health, to ensure the mental health needs of these groups are met. The Minister of State, Deputy Feighan, and I are fully committed to the continued development of mental health services and supports and ensuring access and appropriate care for particular groups of individuals, including those experiencing homelessness and people with a dual diagnosis.

I want to express my disappointment at the title of these statements and questions and answers. Addiction services and homelessness are two issues and are often intertwined but we must recognise that these are two separate issues. Those in active addiction or in need of addiction services are not always homeless. Vice versa, homeless people are not always in active addiction. To say otherwise shows a complete lack of understanding and it is about time this Government stopped insulting some of the most vulnerable in our society. I have a number of questions and I want to give the Minister of State, Deputy Feighan, some time at the end of my section to answer. If he does not have the time to respond to all of them, he might respond in writing.

What public health measures is the Minister of State taking to warn vulnerable adults and children of the harms associated with gambling? There has never been a State-funded public health awareness, education or harm prevention campaign on gambling in Ireland. It is urgently needed and we see from data from the European school survey that Irish males aged between 15 and 16-years old have more than double the problem gambling rate of the general population. The Minister of State knows my feelings on gambling addiction. It is about time this was addressed and, while the Minister of State may be quick to claim that he has no responsibility for gambling and that it falls under the remit of the Minister for Justice, we both know this is wrong and that gambling addiction should be the Minister of State's responsibility.

On the national drugs strategy, when is the mid-term review to be published? Will this look at the impact of Covid-19 on addiction services? Of the 50 actions due to be finished by 2020, will those that have not been completed or started be prioritised or will the Minister of State confirm if new actions will replace them? To be clear, the last data from 2019 show that only four of the 50 actions had been completed. The drugs trade terrorises and stigmatises communities. The national drugs strategy overlooked the fear, intimidation and violence that goes with this. It has become deep-rooted in some of our local communities. Will the revised actions include a strong commitment to putting in place the much-needed long-term and sustainable initiatives that will be required to address these problems? Communities are suffering and they need the Minister of State's support.

What response is being planned to address the challenges in providing addiction services in rural areas and the significant additional challenge of rural isolation and its impact on problem drug and alcohol use?

One hundred and nine beds have been shut in residential rehabilitation services since November 2019. The HSE claims this is due to Covid-19 public health measures. However, I know that some of these beds will never reopen. Can the Minister of State give a commitment to restoring these beds or replacing them, and the timeline for this restoration? In budget 2021, provision was made for 150 additional rehabilitation episodes. Will the Minister of State commit that those 150 episodes announced in the budget will be additional to the 709 episodes lost because of the closure of the 109 beds?

There is much more I could ask but the Minister of State could take a minute to respond.

To be clear, Deputy Gould's colleagues have five minutes left. Is that it?

I can take the answers in writing from the Minister of State.

The Minister of State is off the hook. I will go back to the Deputy's colleague unless the Minister of State wants to take 30 seconds.

Deputy Gould talked about addiction and gambling. It is a very serious issue that I share an interest in with the Deputy. It is also a Department of Justice issue. However, it crosses into our area. I would be happy to meet the objectives and work with them. There are other issues that we need to address and I can send the Deputy a paper on those.

There are two other colleagues to speak. I call Deputy Paul Donnelly.

I thought we had three and a half minutes each. I thought it was 15 minutes.

I am not sure what the Deputy has. I am going by ten minutes. It is between the Deputies and nobody told me.

I will try and be as brief as possible because I want to try and get in a couple of answers from the Minister of State.

During the past year, the most vulnerable group has been the older cohort of drug misusers. In the initial stages, many of the services were closed and some of the workers were seconded to the HSE to deal with other front-line work that needed to be done. Many of them are back, but some of the services have not reopened as drop-in services and they are working through Zoom etc. Obviously, it leaves this group extremely vulnerable.

Between 2012 and 2018, the number of drug overdose deaths among the 50 plus age group increased by 75%. This problem is increasingly associated with older long-term drug users. In the past 12 months, that aging cohort has been more isolated and increasingly vulnerable. As it is clear that they will remain extremely vulnerable, are there any plans for a surge in funding for community-based projects on top of their current funding?

In relation to the broader aspect of the drug and alcohol task forces, I was a member of a drug and alcohol task force for a good number of years on several occasions and I found in the last term I served as a community representative that there was very little support. Originally, we would have had a community development worker. That had gone. My understanding from many of the drug services is that those community development workers have been moved to different positions or the position has been lost. It has broken a link between the community representatives and the community on the ground. It is an extremely important pillar of the National Drug Strategy that there are links between the community, drug and alcohol task forces and the drug strategy. Can we get a commitment that there will be a refocus on community development workers within drug task forces?

The most vulnerable group who are at risk of homelessness would be those who are engaged in drug and alcohol misuse. Can we get a commitment from the Government to extend the ban on evictions up until the end of 2021 and a ban on rent increases to give people security that as we come out of this they will not end up in homelessness?

I will give the Minister of State a good news story for a change to start. Bernard O'Hehir is from Cork City. I know him well. Many years ago, he went through the addiction services. It is well documented. He actually had to lie to get help - that will tell you how serious the service was. He has formally now just finished a little book, Memories & Hope: my long journey from there to here. What he meant by "there" was "in the bad place".

A previous speaker mentioned homelessness as well. It is joined-up thinking between the local services of county councils and city councils and the volunteer groups where resources need to be provided. At present, I have an individual case of a 64-year-old gentleman with underlying health problems who was in emergency accommodation. He was offered a HAP premises. It was utterly unsuitable, even for his health not to mind capabilities to get up three-to-four flights of stairs to access the room. Now the council has put pressure on him. Because he has refused the HAP, it will not support emergency accommodation. Technically, that person will be homeless within a week. We are talking about the Government pumping money in left, right and centre. The commonsense approach does not seem to there.

Another issue the Minister of State mentioned a while ago was dual-diagnosis. It is good to hear it being discussed in the Chamber but addiction can take many forms. It is grand for us to be inside here debating it, but the issue here is that none of us grows up to be a gambler, an alcoholic or a drug addict and to be homeless. It is a societal issue that we have left people down. There is very little joined-up thinking. There are some fabulous organisations on the ground and some amazing people within all the entities, whether it is the council or HSE, but they are not getting the supports. The magic line here is: prevention is better than cure. The issue is that we are a totally reactive society instead of being a proactive society and then when everything festers, we wonder, scratch our heads and ask, "How did that happen?" I appeal to both Ministers of State to start from the bottom up and treat the person rather than the problem in each case and, hopefully, we will address these issues.

Before moving on to Labour, I only can work with the slots before me. There was a ten minute slot for Sinn Féin. I will happily divide a slot up if Members tell me. I will move on. I am simply saying what is there.

I will take that up with the Ceann Comhairle.

That is okay. We will not take up the time now. I call Deputy Kelly.

I have only a few minutes but I want to ask a few questions as part of this. There is a great deal to cover. It is impossible to cover it, ask questions and get answers in five minutes but we will do our best.

In relation to homelessness, I know all of the organisations well and I am very much taken by some of the progress that has been made in the provision of wraparound services, particularly joined up with the approach from the HSE. I welcome much of what has been done. What lessons have been learnt in the past year that we can take on board in dealing with homelessness as we hopefully will come out of this pandemic in a year's time, and can we keep them?

My second question relates to drug and alcohol services. We are all aware that there are limitations in providing services online and not being able to meet. Being able to socialise and meet is part of this whole issue and Alcohol Anonymous, AA, and Narcotics Anonymous have been challenged as regards their meetings. What improvements can we make for them? Zoom does not work. What else are we looking at as we come through this because such services are unlikely to be face-to-face for some time?

A big issue for me is gambling. I certainly do not have enough time to deal with it. I have been raising this in the Dáil for years. The most dangerous development in gambling has been the smart phone. There are pop-up bets, free bets and advertising. My colleagues, Senator Wall and Deputy Ó Ríordáin, launched a Bill yesterday to ban advertising, not sponsorship, of gambling. This is not only a Department of Justice issue. This is a public health issue. During the pandemic, I can guarantee we will see a crisis due to gambling because people are spending so much time isolated, on their own or in family settings. It is so deadly dangerous. It needs to be fully regulated and advertising needs to be dealt with. Will the Minister of State support Senator Wall's Bill? The Senator does not care, as long as we get it through, how it gets through. The Senator is open to any form of changes and amendments. Trust me, societally, we all have to deal with this. Will the Minister of State please help?

My final two questions are for the Minister of State, Deputy Butler. Rural isolation is a significant issue. I spoke to a woman on my way up in the car this morning. She talked about how lonely she felt. I hear this every day. What are we doing to help those who are very isolated, be they in urban or rural areas, in particular those who do not see anyone from one end of the week to the other? In recent weeks, I have taken the time to ring people who I believed were lonely. What measures are we taking? I am glad that we have An Post. I am glad that we have local shops that are making deliveries. That is all these people see. When I told the lady this morning that I was going to mention her - not by name - to the Minister of State, she told me to ask the Minister of State to get on to RTÉ and ask it to at least rerun episodes of "Glenroe", "Bracken", "The Riordans" and "Strumpet City". It was not the worst idea in the world. They were what she was into.

I have a specific question relating to Jigsaw in my constituency. We had the ridiculous situation this week of Deputy Lowry announcing the wrong location for the service. I had known where it would be for a long time, as had the Minister of State's colleague, Deputy Cahill. Forget about all that rubbish, though. When will Jigsaw be open? There have been various statements about staff being recruited and the service being open in the next couple of weeks, but other staff have stated that they will not be recruited and in place before April. When will it actually be open and up and running? A number of previous dates have not been met.

It might buy the Ministers of State some time if they send me something in writing.

Yes. I will get the Deputy a written document with the up-to-date position on gambling. It is a cross-departmental matter, given that it is for the Department of Justice but also a public health issue. I have not seen the Bill, but I would support its gist. A great deal can be done. The Deputy is right, in that the pandemic has increased online gambling. I know that myself. Many young men in particular are gambling online. It is causing major difficulties and is beginning to become a public health issue. The Labour Party has my support in this regard. I do not know what is in the Bill, but its mood is something of which I would be supportive.

I also asked a question of the other Minister of State. Could I ask her to respond now? It is purely because of the time.

I will briefly answer the question on Jigsaw. The lease for Jigsaw's premises in the Tipperary Technology Park in Thurles was finalised as of 5 February. The new premises are within walking distance. Some minor fitting-out works must be done. Due to Covid, those will not be able to commence until 5 March, assuming that is when the construction industry resumes working. Jigsaw is going through the required procurement procedures to get that work under way and concluded as soon as possible. The first members of the team will take up their posts in mid-April, with the remainder starting in the following weeks. All Jigsaw supports across the whole country have gone online. Anyone living anywhere in the country can access them online. I expect Jigsaw in Tipperary to be seeing clients face to face in April or May, but whether it can open its doors will depend on whether we are still under level 5 restrictions.

I understand that Deputy Alan Farrell is sharing time.

With Deputy Cathal Crowe, although I believe there may be a third Deputy who is not present currently.

I will repeat a theme that began at the start of this discussion. During the pandemic, there has been a reduction in the availability of services. The Ministers of State are acutely aware of that. What level of additional funding or support will be put in place presently and as we head further into 2021? It is imperative that we recognise the general depression in society owing to the closure of schools and the lockdowns, which have had a wearying effect on us all after nearly 11 months. Unfortunately, this has consequences. Some individuals have taken to substance abuse. It must be recognised that we need to put in place the necessary funding and services to ensure they are supported.

My constituency has a young population in Swords, Balbriggan and emerging communities like Rush, Lusk and Donabate, all of which have more than 10,000 people. Fingal has the youngest and most diverse community in Ireland. The combination of the closure of schools and lockdowns has had unfortunate consequences. Foróige has a drug education service programme. We need to consider such alternative service providers for additional funding. I appreciate that this suggestion will cover many Departments, not just the Department of Health. What measures will be taken to support urban centres and, in particular, emerging communities like Balbriggan and Swords? What plans are being developed by the Department of Health to ensure the continuity of addiction services that have been provided throughout this extended period? Given its prevalence globally in recent years, the issue of opioid substance abuse is topical. The State offers treatment programmes. Perhaps the Minister of State, Deputy Feighan, will comment on them.

Since the onset of Covid-19, 900 additional people have been seen by the opioid substitution treatment programme. They are being retained as part of the existing service level. Some €4.2 million has been provided for the service's continuation in 2021.

I have met all of the drugs and alcohol task forces and we are allocating funding. However, there are many initiatives, for example, Know the Score in respect of young children, and I hope to work with them.

I wish to put a number of points to the Ministers of State and I hope that they will be able to respond within time.

Yesterday morning, I met Family Carers Ireland's County Clare branch, which is led by Ms Vicky Ward. It was a virtual meeting, as everything has gone virtual these days. Nonetheless, it was nice to be able to see the carers and engage with them. They have two significant concerns and I hope that the Ministers of State will be able to give them some assurances or indication of what will happen.

First, they seem to be way down the pecking order on the schedule of vaccinations. Actually, they do not really know where they are in the pecking order. The obvious approach to take is to categorise family carers, who care for vulnerable people in their home environments, as key workers. If we did, they would be at level 6 in the 15-point vaccination roll-out plan.

Second, they are finding it difficult to secure PPE. It is impossible. The HSE works like the spokes of a wheel. Imagine the local GP, pharmacy or primary care centre as being on the outer rim. That is the obvious point on the supply chain where family carers should be able to get sterile nitrile gloves and all of the other PPE they need to care for their loved ones at home. They are front-line workers, keeping people out of acute hospitals and filling a key role during this crisis. I ask that my suggestion be considered.

There is no discharge co-ordinator for the new 60-bed block at University Hospital Limerick. This means that when someone is about to be discharged but still requires acute care in the community environment, there is no one to devise a plan for the local health nurse and other local support mechanisms. Will the Ministers of State respond to this point?

I thank the Deputy for his questions. I have met Family Carers Ireland and healthcare workers. We must consider the situation as it stands. Approximately 300,000 vaccine doses have entered the country and we had allocated 272,000 of them as of last night. We must keep a small buffer of approximately 20,000 every week so that the person who needs a second dose within 28 days can get it. If the supply was distorted for a week, we would need that buffer.

Unfortunately, 4,036 people have lost their lives, of whom 93% were over 65 years of age.

To date, the group of vulnerable people has included our older generation and family members living in nursing homes and this prioritisation of older people has been correct. The Minister, Deputy Stephen Donnelly, said in the Dáil last week that he has asked the National Immunisation Advisory Committee to look at the prioritisation again with regard to a large cohort of various groups. It will make some recommendations in the next two days.

A number of weeks ago, I engaged with the Minister, Deputy Darragh O'Brien, on a number of issues with regard to private emergency accommodation, which is a rapidly increasing proportion of the accommodation provided and, it seems, a very profitable one. The Minister persistently referenced the role of local authorities and the Dublin Region Homeless Executive in tackling our homelessness crisis but I believe the Government has a core duty in this area, of course in terms of policy and funding but also in ensuring legislation is adhered to and proper systems and governance structures are in place, particularly when it comes to private emergency accommodation and providing addiction and healthcare services to those who need them.

The HSE and the Department of Health have a particular role to play in terms of how they interact with private emergency accommodation in their role on the joint homelessness consultative forum. If I may focus on the links between addiction, mental health support and homelessness, all three are intrinsically intertwined and people can experience one, two or all three of them at periodically different points over their lifetime. The causes and consequences of homelessness are multifaceted and this should be recognised and addressed within the system of homeless services that we as a State provide, whether through private or public structures.

We need to see national guidance on the private provision of services. Specialist mental health professionals should be a formative part of the homeless services we provide. Specialist teams should engage in active outreach for every person experiencing homelessness, providing aftercare planning and assisting people into a home. My fear is that this is not happening where the service is privatised. For example, a small success over the past year has been a lowering of the barriers for those seeking to get on methadone, which is itself now recognised as an addiction issue. This is more difficult when the take-up of addiction programmes requires timely and direct access to information, staff and supports that might not be available in private providers. There is a lack of clarity about the quality, regularity, availability and efficacy of support services in private accommodation. What oversight does the Department of Health undertake to ensure that private providers in the sector are staffed with people who are fully Garda vetted and suitably qualified? We need to ensure that adequate physical, mental and emotional health supports are available within these private providers.

What oversight does the Department of Health have on the standard of accommodation being funded through the taxpayer? What is the frequency of unannounced inspections carried out by HIQA? Does HIQA carry out inspections? To date, what information has the Department collected on private emergency accommodation? Is the Department fully compliant with current procurement and tendering practices in the contracting of privatised emergency accommodation? We have increased spending in this area since 2016 by a huge percentage and have increased capacity by only 237 people. What are we seeing for this rise in cost?

I do not recognise the system the Ministers of State have described this morning. It is not my experience, particularly with regard to the wraparound supports that are supposedly available to those with problematic substance use who have become homeless. I say this not to score points but with the hope that the Ministers of State will move beyond the rhetoric and look at the real challenges facing people in these circumstances.

We are speaking about people who I would describe as adults at risk, who find themselves homeless and who might be on a drug or alcohol programme. They might be drug or alcohol free if they are lucky. They have changed their lives around. Some of them might be coming out of jail, full of hope and good intentions, determined to change their lives around and not repeat mistakes. What happens to these homeless people? If they are lucky, they are offered a couch or a bed and to stay with friends but for the majority it is the hostel route. The first challenge then is to get a bed but they are not given a choice about that bed. They are put into an environment of active drug users and alcohol use. It is a system set up to fail and this is the point I want to make this morning. The odds are against anyone going into one of these hostels with regard to staying off drugs. In many cases, they go into an environment of very active intimidation. If people go into dormitory-style accommodation and those around them are injecting, taking drugs or smoking, it is very difficult not to partake. Equally, it is difficult if those in these circumstances, with the backgrounds they have, have had difficulties in the past with drugs.

Wraparound services for those in these difficulties do not exist in many cases. We can ask people who are sleeping rough tonight. I saw enough of them sleeping in doorways as I came in here this morning. What they will all say is they feel frightened and intimidated going into these hostels. We spend an absolute fortune in taxpayers' money on the homeless situation but we are putting people in danger. We are putting people at greater risk. I am asking the Ministers of State to intervene and become more active and be a voice for those people who want a choice and want to be put into a hostel that is drug free or alcohol free. Perhaps this morning we should be arguing for giving people more choice to support those in these circumstances. I would love to hear the Minister of State, Deputy Feighan, saying he might go down this route and might take the path I am asking him to take.

I thank the Deputy for raising this issue. I have met many of the stakeholders. It is not rhetoric. I am informed that in 2020, some 1,006 single persons exited emergency accommodation into homes in the Dublin region. A lot of work has been done regarding rough sleeping and long-term users of emergency accommodation. It is not perfect but much good work has been done and we are putting a lot of resources into achieving it.

When we are given long presentations, such as those we have heard this morning, I am often fascinated by what is missed and what is not said. I am quite surprised that the Minister of State, Deputy Feighan, did not refer to drug-related debt or intimidation, which are endemic not just in my community in Dublin Central but in communities all over Dublin and - I imagine - all over Ireland. I ask the Minister of State to tell me if I missed such a reference in his presentation. Issues relating to drug-related debt cannot be separated from the experiences being catered for and trying to be managed by drug services and homeless services. I am very interested in why this was missed in the presentation and I will build my first question around it. We are coming up to the midterm review of the national drugs strategy. Will the midterm review factor in how endemic drug-related debt and intimidation are? Will the Minister of State provide these services? What models will they consist of? I would be shocked if drug-related debt and intimidation were not factored into the midterm review of the drugs and alcohol strategy.

My next question also pertains to the midterm review of the drug strategy and the health diversion programme. Will the health diversion programme, which I believe has inbuilt limitations, continue to criminalise people in their struggle with health and trauma-related illness if they have more than one conviction for possession of drugs? If that is the case, any conversation about empathy or understanding goes out the window if we continue to criminalise people who I do not believe are committing crimes.

I thank the Deputy. I had a speech prepared that would have taken 15 or 20 minutes but, as the Deputy very rightly said, I had to remove something because I only had ten minutes. Regarding drug-related intimidation, I am very aware of such activity. An active illicit drug market leads to intimidation and a frightening environment for families and communities. A key action of the national drugs strategy is to strengthen the effectiveness of the drug-related intimidation reporting programme. I will speak about this in the national midterm review. If the Deputy wishes, he is more than welcome to make submissions to the midterm review and I will be happy to meet him because this is a very important issue. The National Family Support Network has funded a drug-related intimidation trainer co-ordinator.

The gardaí are very aware of that. The network has carried out evaluations of the drug-related intimidation programme, which has resulted in a number of improvements in its effectiveness. I look forward to what the Deputy stated.

There are issues with the health diversion programme. We are working with the Department of Justice to implement the programme. It is part of the national drugs strategy and I look forward to phasing it in. On the costs involved, there will be a pilot programme involving five different areas around the country to determine how it works.

The Minister of State referenced the drug-related intimidation project work, which was an initiative of the National Family Support Network. It is very important to state that the role referenced by the Minister of State ceased almost a month and a half ago. It was a success, but has now been defunded. One of the last acts of the project was the commissioning of a report which demonstrated that in a very small part of the north inner city more than 20% of respondents who were surveyed said they had suffered from drug-related intimidation.

There is an urgent need to get this right. I would strongly encourage the Minister of State to not just to get it right in my constituency and draw a line around it, but to get it right all over the country. We need a new model and approach to how we deal with the consequences of drugs. It needs to be trauma informed and led. I would be happy to partake in those discussions. We should widen them and there should be a collective effort because for more than 40 or 45 years we have applied the same mechanisms in our response to drugs and we keep getting the same old outcomes, namely, continued marginalisation, violence and deprivation. I would love to partake of those discussions.

I ask the Minister of State to factor us in. The discussions should be evidence led. Let us stop repeating the mistakes of the past. Most specifically, we should stop criminalising people who have experienced huge trauma and are self-medicating for that reason. If we can get one thing right over the course of the next few years, it would be to fundamentally change how we deal with this issue as a Republic.

I welcome the Ministers of State to the House, as well as the opportunity to discuss drug, alcohol and homeless services during the Covid-19 pandemic. During the first wave of the pandemic services for the most vulnerable people were severely impacted. The resumption of services for people with drug or alcohol dependency and the continuation of homeless services is to be very much welcomed. It must be noted that the impact of Covid-19 restrictions are not equal. People who are homeless or those living in overcrowded accommodation find it much more difficult to self isolate or restrict their movements and interactions. This is compounded in cases where there is an addiction or alcohol or drug use.

People often have complex health needs. People who are homeless are at a higher risk of contracting Covid-19 and are more likely to require emergency healthcare services during the winter months. I welcome the extra funding provided by the Government and the Department, along with the HSE winter plan, to support people who are homeless. In particular, the €4 million allocated by the Department to address the addiction and mental health needs of people who are homeless is very welcome. I understand this includes health supports for 218 new tenancies under the housing first programme and customised healthcare plans for 1,300 people living in single person accommodation.

Some of the individual measures in Dublin are especially welcome. They include: the continuation of the seven-day dedicated homeless response team; the operation of a 110-bed isolation unit for homeless families and single people, supported by nursing, GP and social care services; health supports for 250 people cocooning while living in private versus accommodation; support for single people who are homeless, including an 18-bed unit for people with complex needs; and provision for mobile testing, tracing and self isolation facilities for people who are homeless with suspected cases of Covid-19.

I want to acknowledge the efforts of everyone in this area, in particular those on the front line, local authorities and organisations such as Inner City Helping Homeless which has continued to do fantastic work throughout the pandemic. In the medium term it is important to acknowledge the success of the housing first programme. I look forward to seeing these critical initiatives expanded in line with the commitments in the programme for Government.

Can the Minister of State confirm the number of residential treatment places available for people in need of addiction support? Are there plans to increase the number of beds? I ask for a response on that in writing.

I would like to make a point to the Minister of State, Deputy Butler, on vaccine availability for carers. She has given this serious consideration. I would like to lend my voice to those comments.

The past year has been very tough for many people. During this lockdown, in particular, it is clear that many people are feeling lower than ever before and are really struggling this time around. Loneliness, isolation and the loss of loved ones has taken its toll on so many. There is light at the end of the tunnel and we know that vaccines are on the way. The good news about the Johnson & Johnson vaccine yesterday is proof that brighter days are ahead.

However, I am worried that the necessary lockdowns and associated social isolation so many have experienced may result in a mental health pandemic and an increase in the substance use and addiction. Employers, social workers and gardaí all report a significant increase in mental health issues. Drug and alcohol addiction and mental illness are often linked. The last three lockdowns have resulted in people drinking at home far more than previously. There is absolutely nothing wrong with having a drink at home, but there is growing evidence that for many people binge drinking at home is on the increase. Arising from this, there are higher rates of domestic abuse and more frequent calls to helplines, especially to the likes of Childline. This is very worrying for our young people.

The staggeringly low prices of alcohol in off-licences and large supermarkets is leading to increased rates of binge drinking, especially in our homes. We have to address this. We must commence the Public Health (Alcohol) Act 2018 so that minimum unit pricing comes into effect. This legislation aims to combat harmful drinking. The current pandemic is further proof that it is time to enact this legislation without delay.

Minimum unit pricing is long overdue. The longer the Government waits to enact these laws, the more alcohol will be abused. This is resulting in major damage to people's health. Alcohol abuse in the home also has a seriously damaging effect on the mental health of the young people who witness it. The longer the Government waits to tackle alcohol abuse, in particular in the home, the longer the vicious circle of alcohol dependency and addiction will continue through the generations. This needs to be addressed.

While I am on the topic of mental health, I was delighted to welcome the news from the Minister of State, Deputy Butler, this week that a suitable location has been found for the Tipperary Jigsaw centre that will be located in my home town, Thurles. She told me during a Zoom call on Monday that a lease was signed between two parties which will see Jigsaw being located in Tipperary technology park on the Nenagh Road outside Thurles. The facility will be within walking distance of the town centre and will provide mental health supports and services for the young people of Tipperary.

It is important to stress that these service are currently available online for people all over the country. I thank the Minister of State for the significant effort she has put into securing this service. It is something for which I have campaigned since I was first elected in 2016. It gives me great satisfaction to see the lease finally signed. The service will be up and running in early spring.

Last week in my constituency, Ballymun, we saw the death of another man related to the illegal drugs industry. While other Deputies have spoken about addiction to gambling or alcohol, the reality is that if this gentleman had not had an addiction to illegal drugs he might likely be alive. If it is difficult to deal with the alcohol or gambling industry, try dealing with the Kinahans.

The reality is that we need to consider the commitments in the programme for Government to move towards examining how we dismantle the organised crime industry around the supply sale and supply of illegal drugs and ensure that we deal with people who have an addiction in a humane and health led way. In order to do that, we need to fund our local drugs task forces. I ask the Minister of State, given that there has not been an increase in funding for these task forces for more than six years, whether he can examine what funding might be available in next year's budget to ensure that we support this important work.

I have made more than €1 million available for local drugs task forces.

We also have up to €460,000 for targeted initiatives which we are seeking from various task forces. Again, I pay tribute to the great work the task forces are doing. I am aware of the awful situation in the Deputy's constituency, and the Deputy raised it with me previously. I am looking forward to a report that is due to come from the constituency. That will inform us of how best to move forward as well. I thank the Deputy for raising these issues. I am available to meet the local task force when we are allowed to after the Covid-19 lockdown. However, I have met most of the task forces online.

Funding for local drug task forces is €3 million less than it was ten years ago, despite repeated promises from successive Governments. As a former director of the Clondalkin Drug and Alcohol Task Force, I have seen at first hand how addiction services have tried to do more with less. Drug and alcohol task forces need multi-annual funding to provide the services their communities desperately need. In 2019, almost €69 million was seized by the Criminal Assets Bureau, CAB. This money originated in areas with high levels of deprivation, such as my area in north Clondalkin. The deprivation and poverty were caused by systemic failures in Government policies.

Drug intimidation can take many forms. One can walk around some previously quiet estates in Clondalkin and see drug dealing taking place with relative impunity. Neighbours are absolutely terrified. The money these unscrupulous drug dealers are getting is money that, hopefully, is eventually seized by the CAB. This money must be put back into these communities. The money that goes to the CAB originates from the purses of mothers who are paying drug dealers due to intimidation. It should be ring-fenced to build resilience in communities. It should not be used to replace current funding or as an excuse not to increase further funding down the road. It should be used to resource community initiatives in the communities that have been failed by successive Governments. Has the Government even considered putting the money that has been ripped from our communities directly back into them?

People who have dual diagnosis often fall between the gaps. Addiction and ill mental health often occur hand in hand. An addiction may lead to the onset of a mental health issue, or a mental health issue can lead to people using substances as a coping mechanism. Due to the inadequacies in the State's mental health system, people can turn to drink and drugs to bring calm to an anxious inner world. Deputy Gould and I have legislation, the Health (Amendment) (Dual Diagnosis: No Wrong Door) Bill 2021, that is due to come before the House on Second Stage, and I will ask the Government to support it when it is before the House.

Finally, one has only to walk through parks and estates to see discarded nitrous oxide canisters, which are also known as "silver bullets". As community structures for children, such as sports, schools and youth clubs, have been decreased due to the pandemic and restrictions, the use of nitrous oxide has increased. The problem is that children are playing Russian roulette with this substance. They do not know how it will affect them until they take it. What measures has the Minister of State taken to combat this? Does he still believe it is just a Dublin problem, as he stated previously?

First, I agree with the Deputy regarding the ring-fencing of funding. My colleague, Deputy Richmond, and others have been to the forefront in that regard, so perhaps it is time for a debate on the subject of putting the money put back into the local drugs task forces or into addressing the issues. On the funding, in November 2020 I approved one-off funding of €20,000 for each task force, including the Deputy's local task force, to assist in the continuation and restoration of drug and alcohol services during the pandemic. I have also allocated an additional €1 million for a new funding scheme for task forces in 2021, to increase the core funding. I have met all the task forces and I have asked them to let us know what they require. My departmental officials and I will do everything we can to help them with their funding or whatever resources are necessary. It is an issue, and I thank the local drug and alcohol task forces for the work they are doing to address this awful problem.

I thank the Minister of State for his statement. This is probably the first time I have formally engaged with him so I wish him well during his tenure in office. We have different views on alcohol and drug policies, but as the conclusion of the Minister of State's statement says, it is about harm reduction. That is what it is about, because the previous policies of other Governments have been a failure. Obviously, the pandemic has imposed major pressures on alcohol and drug intervention supports. People cannot go there physically now and that is causing big difficulties for people for whom they were an outlet. That is not available anymore, and it is not the same doing it remotely. There is a big lacuna in that regard and, hopefully, that can be addressed in the next three or four months.

I have a number of questions for the Minister of State about the drugs strategy. In my opinion, the current policy is a complete failure. It is failing people. It is good that the Minister of State referenced health inequalities faced by people who are homeless and in addiction. This is a societal matter that must be teased out. The debate on decriminalisation has been ongoing for years. It goes around and around, but nobody answers. I understand the Citizens' Assembly will discuss decriminalisation. We have to understand what decriminalisation means. It is decriminalising the person, rather than the drugs the person has for personal use. We want to find out when the Citizens' Assembly will discuss this and if there will be decriminalisation for personal use. It has worked in other jurisdictions. Will this be implemented?

I believe we must go further than decriminalisation in respect of certain drugs, particularly cannabis and the possession of cannabis. Bringing people through the criminal justice system, that is, bringing them to court and giving them sentences and criminal convictions, is a failure. What is the Minister of State's opinion on the legalisation of cannabis in the drugs strategy during his tenure?

I thank the Deputy for the measured way in which he put his views forward. We come from different perspectives, but between us we try to get the best possible answers to this very difficult problem. The national drugs strategy sets out a health-led approach to drug use and it promotes a more compassionate and humane response to people who use drugs, with drug use treated as, first and foremost, a public health issue. As the Deputy knows, the Government established a working group and that group decided it would opt for the health-led approach to possession of drugs for personal use. Effectively, what we are trying to do with a first offence is to get people to interact with the health services on a pathway to recovery, avoiding a criminal conviction.

We have met the Cannabis Risk Alliance group, which offers another perspective. The group includes GPs and psychiatrists with significant expertise in the fields of addiction and psychiatry. They are also parents. They outlined the damaging effects of cannabis, particularly for adolescents. We cannot be complacent about the risk to health posed by illicit drugs, but we have set out a health-led approach. Hopefully, the health diversion programme will be a start whereby people who are caught in possession for the first time will get a health diversion programme. Second, it will be at the discretion of the Garda. However, I cannot envisage legalisation because sometimes it leads to decriminalisation which can have a knock-on effect. I would welcome the Deputy's submissions to the mid-term review of the national oversight committee. I thank the Deputy for his observations and his co-operation as we work on trying to resolve this issue.

I thank the Ministers of State for coming to the House to speak on this important issue. I speak as a former member of a ministerial drugs task force. I empathise with some of the points raised by people who are directly involved on the ground in dealing with the addiction issues. Very often they have a different perspective than that which we as legislators have. I always saw methadone as a means to an end, not an end in itself. Unfortunately, over the years, the aim of its use has become vague. We need to go back to base on that. I do not agree with my colleague, Deputy Gino Kenny, on legalisation. We have too many gateway drugs. These may not be the worst substances but they do lead to others which are serious. The late Martin Naughton used to say if a person has a mental or physical disability, they certainly have a problem, if they have a mental or physical disability and an addiction, they have a problem but if someone has all those and is homeless as well, they will really have a serious problem. He was correct and I pay tribute to Martin Naughton and the work he did for people with disabilities for many years.

I ask the Ministers of State to give an indication on whether the programme for Government commitments on harm reduction programmes can be kept on track. I emphasise harm reduction in particular. It is about reducing harm rather than resolution but we have to start somewhere. Is the Minister of State satisfied he is on track and will continue to make a meaningful and positive impact in reducing harm, and that he has the resources to do so?

Others have mentioned residential places for treatment. It is impossible to get a residential place for a person who has an addiction. If they have a mental health problem and other problems, and also have an addiction, we cannot find places for them. The services are coming down with requests making it very difficult for those at the coalface, providing the direct service to do the job they are expected to do.

The Department of Health harm reduction element of the health diversion programme provided €100,000 in 2020 to develop a national harm reduction campaign to raise awareness of the risk associated with drug use. The campaign will be delivered in 2021.

I wish to raise the 24-7 helpline for people with drug and alcohol addiction. What is the status of this? It is very important because drug and alcohol addiction does not go away at 5 p.m. and there is a need for a 24-hour helpline.

Some Members have raised joined-up thinking and co-operation between local authorities and the prison services. I was recently working with a voluntary group in Cork at night. We were outside the Simon Community in Cork and met a girl who had been discharged from Limerick Prison that day at 3.30 p.m. She got a bus to Cork but there seems to have been no joined up thinking to ensure that she had some place to go once she was released from prison. Can we do a lot more in the area of co-operation? Similarly, when someone is discharged from mental health services, it should be ensured that they have an adequate place to go. We need to do much more in co-operation in this area. I would like a response on those issues.

On the 24-7 drugs line, there is a drugs helpline in the UK that we have been trying to mirror. It is called Talk to Frank but it will not be called that here. There is a budget allocation of €170,000 for the service and the recruitment of three addiction counsellors is under way. It will not be 24 hour but it will be expanded to what we think will be needed, based on advice from stakeholders.

On the issue of the young lady, I ask the Deputy to give me the information and we will try to determine how best to address that.

I wish to take this opportunity to highlight the work of Clondalkin councillor, Kenneth Egan, who has been lobbying for the proceeds of crime seized by the Criminal Assets Bureau, CAB, to be invested back into the communities which have been so negatively impacted by drugs, the drugs trade and the anti-social behaviour and crime that comes with that. He recently discussed this with the Minister for Justice, and Deputy Richmond has been drafting legislation on this. I am glad to hear the Minister of State say that he would welcome some of that money being reinvested into drug task forces such as the one in Clondalkin.

I thank the Minister of State for everything he has done on nitrous oxide canisters. One in four festival goers in 2019 used nitrous oxide to get high. They became a huge issue in my area during summer, littering parks in Lucan and Clondalkin. Thankfully the prevalence of silver bullets strewn across our parks and footpaths dissipated last year. Unfortunately, the latest lockdown has seen a resurgence of teenagers using nitrous oxide canisters to get cheap highs. Again, the silver bullets can be seen on our streets and in our parks.

Social restrictions have challenged us all in so many ways and it is natural that people are turning to escapes from reality. Many see nitrous oxide as a low risk laugh but it can have life threatening and even grave consequences. Neurologists are crystal clear about that and, sadly, families across the country have seen this first hand. We need young people to understand the dangers these canisters present. We need their parents to be on the lookout for deliveries of boxes of nitrous oxide canisters to the family home by courier. These canisters can be purchased online for as little as €2 and delivered straight to one's door. They are too readily available and too affordable not to become a temptation to bored teenagers during lockdown, but those teenagers need to understand the risks and it is our job to protect them from those risks.

Social restrictions have also had an impact on those struggling with addiction. Pregnant women and those who have recently given birth are particularly vulnerable among those overcoming the challenge of addiction. For them, it is not just about getting their life back on track but also providing a future for their child. What supports have been put in place to better support pregnant women and new mums and their children affected by substance misuse?

Unfortunately, the issue of drugs in my home city of Limerick has worsened during the pandemic on what seems like a daily basis. The issue is not new. Previous Ministers have failed utterly in dealing with the issue and sometimes I wonder if they bothered at all. There is a specific problem in the St. Mary's Park area of Limerick which I wish to raise with the Minister of State. I mentioned this estate to him before and to the Minister for Justice. I have also raised it with the Taoiseach and the Tánaiste. It needs urgent intervention from the Government with additional resources from An Garda Síochána, the Criminal Assets Bureau, the Courts Service, Limerick City and County Council and other agencies.

This is an older, very settled housing estate with many wonderful working families who have lived there for generations. It has some of the finest people one will ever encounter. Many of them are my friends. They worked all their lives when they could. Now it feels as though drugs and drug gangs have taken over and, worse still, seem to operate with impunity. These drug dealers ignore planning regulations regularly, building unauthorised structures that need to be removed but which remain in situ, with public land grabbed and retained which needs to be reclaimed, and walls built in total disregard of planning regulations. As we speak, a structure is being constructed for which there is no planning permission. Council officials have told me privately that they are afraid to enforce many of the regulations. Derelict houses that are due for demolition are used to store drugs.

Despite Garda requests, these structures remain in situ as the warehouses of the wicked.

The Defence Forces were deployed last year in Limerick to assist the Criminal Assets Bureau. They should be called on again, if necessary, to deal with the ongoing problems.

The local drugs gangs regularly give two fingers to everybody. The two fingers from these drugs gangs are not just to me, the local community, An Garda Síochána or Limerick council; they are two fingers to the entire State.

In drugs seizures across the city, crack cocaine was among the drugs seized. Crack cocaine, as the Minister of State knows, is a devastating drug. It has destroyed communities across the world. It is extremely addictive and is regarded as the most addictive form of cocaine. As I have said previously in the Dáil and will repeat, there really is a special place in hell for anyone who sells, distributes, benefits or profits from the sale of crack cocaine.

Unfortunately, drug dealing operates like a 24-hour drive-through. Taxis often form queues while people from all over the region purchase their drugs. Many people simply walk into the estate. It is like a non-stop drugs supermarket. The vast bulk of people getting their drugs do not live in the area.

It has been said to me that the most vulnerable can be brought to court for often very minor offences but drug dealers, many facing serious charges, can swan around the city selling their filth while ruining lives and communities.

In the mid-2000s the drugs problem in Limerick was ignored. That cost us massively. It cost the State resources and it cost people their lives. The failure to act then ultimately led to a need for massive Government intervention, which ultimately led to the Limerick regeneration programme. I implore the Minister of State to act now. He has no time to lose. We do not want to return to those very dark days. The residents need assurance that they are not being abandoned. I am in contact with them on an almost daily basis. They feel utterly abandoned.

In terms of my question to the Minister of State, we need a specific task force in the area that could be modelled on what has been achieved in areas of Dublin. Will he commit to doing that and to talking to his colleagues?

Last June I wrote to the predecessor of the Minister, Deputy Stephen Donnelly, pointing out that Portiuncula University Hospital, in Ballinasloe, was in a desperate situation because it had lost 10% of its acute hospital bed capacity due to Covid-19 reconfiguration. The hospital took a very proactive approach with regard to it and forwarded two very specific proposals to the HSE. The first was to develop two separate modular buildings - one for the accident and emergency department that would segregate Covid and non-Covid patients, and one to take the outpatient department out of the acute hospital and convert the old outpatient department into 13 single rooms. Currently, Portiuncula hospital, which is one of the biggest acute hospitals servicing the midlands, has only 13 single rooms. To compound that, it is down by 10% in terms of its bed capacity.

While funding has been forthcoming for the modular building for the outpatient department, refurbishment work has not taken place in the old outpatient department and funding has not been provided for the second modular building for the accident and emergency department. As a result, the hospital is operating at 10% below its capacity today, with just 13 single rooms, and is not in a position to manage the pandemic and the day-to-day challenges it is facing.

Thirty-six days ago here in the House I asked the Minister if funding will be provided to expedite the refurbishment of the old outpatient department. I also asked him if he would provide funding to ensure that we had a modular building to deal with the unacceptable situation we are currently experiencing in the accident and emergency department. On 13 January, the Minister said he would revert to me with the response with regard to that. I am still waiting on that response, and more than 130 patients in Portiuncula hospital have waited on trolleys overnight since the Minister gave me that response. Can I have a response today as to what is happening in Portiuncula hospital?

I thank the Deputy. Portiuncula University Hospital in Ballinasloe is an acute general and maternity hospital that delivers a patient-centred, quality-driven, focused service and provides a wide range of diagnostics and support services. The hospital's catchment area includes patients residing in east Galway, Roscommon, the midlands and mid-western areas.

As part of the winter 2020 plan, additional space will be provided at Portiuncula University Hospital with a prefab modular building for segregation, which will provide an immediate solution for emergency department streaming for winter 2020 at the hospital. The modular building proposed will provide for 14 temporary Covid-19 emergency department, ED, minor injuries treatment and assessment rooms, with associated support facilities. The unit will have a residual value for the displacement of outpatient accommodation after the Covid-19 emergency.

The construction works to the modular building at Portiuncula University Hospital will be complete by the end of the first week of March 2021. The hospital will commission the building for occupation of the outpatient department in the week ending 12 March 2021 and it is expected that the modular building will operate as an outpatient department from Monday, 15 March.

The HSE has advised that it is intended to advertise for contractors for the construction of the 50-bed ward block at Portiuncula University Hospital in the first quarter of 2021 with a view to commencing works in summer 2021, subject to the availability of funding.

I thank the Minister of State for his response and providing at least some clarity on this matter but we still will not have additional bed capacity as a result of that. I ask him to take that back to his senior Minister.

There is no doubt that we need to get more vaccine into the country but we also need to ensure that when that vaccine comes it can be administered to people as quickly as possible. An online portal has been established for this process and that will be key to administering those vaccines. Currently, pharmacists are in the process of registering online to be vaccinated but the system is not fit for purpose. For the past number of weeks people have been unable to register on it. One individual contacted the HSE nine days ago with regard to it and has not received a response. Those who have been able to register on it have not yet received a confirmation email to say that the registration has been recorded and no one has received an appointment for vaccination. The HSE has acknowledged that the system is not working because it has now put a helpline in place but if we cannot organise the online portal for registering pharmacists how, in God's name, are we going to do it when we have 65,000 people a day availing of vaccination from May of this year based on the current commitments in terms of delivery? We really need to get this right.

The final point I want to make relates to the impact the lockdown is having on other health services. While community nursing staff are carrying out health screening checks on children, those referred for audiology are left in an appalling situation. I will give the figures for Roscommon and Galway but it is being replicated across the country. In Roscommon, the current waiting time for paediatric referrals for audiology is 56 weeks; for adults it is 76 weeks. In Galway, it is 55 weeks for children and 72 weeks for adults. How can we ensure that children will be able to engage in education and in society if they cannot hear and they cannot get an appointment with an audiologist?

Substance abuse, principally drug and alcohol misuse, is rising throughout our country. As a rural Deputy, I see the growth of drug use in every corner of Cavan-Monaghan and north Meath. It is no longer confined to towns and the margins of society or shadowy places. It is in every strata of society in every village and townland. Young and old are represented in drug misuse statistics and the longer people sustain drug misuse, the more likely they are to die because of that misuse. There are more drug-related deaths than road fatalities. That is staggering.

At an AA meeting, new members introduce themselves by their name and their admission of addiction, which is the first tentative step of acknowledging the problem and seeking recovery. I fear that we are not near that stage with drug addiction in rural Ireland. With the availability and spread of drugs throughout the country we are in danger of losing a generation if we do not engage with the issue as quickly as possible. We must start by recognising the problem and its extent, having support groups within towns throughout the country, ensuring there are resources and services dealing with the addictions, and widely promoting and making helplines available.

The social acceptance of drug and alcohol use has severe implications for the longer term. Serious health problems are being stored, and dysfunctional families and lost individuals are other consequences. Peer education surrounding the dangers of alcohol and drug misuse is another venue worthy of developing and piloting nationally. The dated approach we have seen up to now of lecturing and highlighting risks is now seen as counterproductive. The power of peers promoting health and well-being among youths and within clubs may achieve much more.

Will the Minister of State continue her endeavours in making Jigsaw a priority in Cavan and Monaghan, as we have one of the highest rates of youth suicide in the country?

I thank the Deputy for her question, as she has demonstrated a concentrated effort over many years in dealing with youth mental health matters. As we know, Jigsaw provides services for young people between the ages of 12 and 25. We are currently in a level 5 lockdown but Jigsaw supports are available to everyone online. Young people can use those services through Facebook, Instagram, Twitter or by logging on to www.jigsaw.ie. Those supports are there for everybody, regardless of where they live. I will continue to work with the Deputy on getting that physical presence in Cavan and Monaghan.

I thank the Minister of State for taking the time to discuss access to drug and alcohol treatment services during the Covid-19 pandemic. Covid-19 poses a major threat for people with drug and alcohol addiction and, in response, drug and alcohol services have adapted with new ways of working to continue to support people affected by substance misuse during the pandemic. Their work should be commended.

A key priority for the Government during Covid-19 is to protect, safeguard and support health, social care and other essential services. The safe resumption of community-based drug and alcohol services is a key component of this approach. Drug and alcohol treatment services are playing a vital role throughout the country in reducing harmful substance misuse and supporting rehabilitation and recovery. Covid-19 is a stressful time for people right across the country, leading to a rise in the level of alcohol consumption. According to the latest Drinkaware report published during the summer, one person in four is drinking more since Covid-19 came to Ireland. It is clear alcohol can be used as a mechanism to help people relax and unwind, but we must recognise the changing pattern in alcohol consumption and habits the pandemic has brought about. We must ensure the people who feel they need help in this period to tackle a potential alcohol addiction can get access to the supports they require.

Drug and alcohol treatment services have had to adapt to new ways of working to continue to support people affected by substance misuse during the current pandemic. I welcome the provision of €480,000 in once-off funding to support the restoration of drug and alcohol services. I sincerely ask that the Government continues to give whatever financial assistance is required to ensure these services can continue to operate efficiently.

It is important that we start a national conversation around alcohol use. The Drinkaware report highlights that 25% of people also saw a decline in alcohol consumption, highlighting the changing nature of drinking patterns, which is quite interesting. Understandably, much of the change in drinking patterns has been due to extended periods of reduced contact and isolation, and we must therefore monitor these patterns of behaviour as we emerge from the pandemic to ensure the right form of services are available. Addiction may be caused by many factors, and we should not stigmatise people who suffer from addiction. It is an illness and we must treat it as such.

Covid-19 has had many profound effects on people throughout the country and the relationship with addiction is one of them. We must ensure we have the necessary support in place to meet such challenges.

This week, from 14 February to 20 February, is international children of alcoholics week, so it is a good week to raise matters that affect children in this way because of Covid-19. According to the independent research of the Silent Voices initiative, one in six children lives in a home with problem parental alcohol use. This has become much more of an issue in lockdown and I am deeply concerned about the continued closure of schools, a place where children affected by these matters could reach out to find support.

A study by Alcohol Action Ireland and University College Cork has reported an approximate figure of 200,000 children living in households seeing an impact from alcohol use, with a further 400,000 raised in homes where alcohol abuse was a feature. It recommends mandatory training in schools to recognise pupils experiencing these challenges at home but children are not in school now, so what is being done to support teachers working online or checking in once a week? How can they support these children and what plans are there to bring such support when the schools reopen?

There is also the question of funding for support services in the community. In the past I have raised how matters often cross Departments, and alcohol dependency and addiction, for example, can often cross into the Departments dealing with justice or housing matters. This week I was contacted by the Carlow Women's Aid, which is under pressure because of funding shortages. These types of service are vital for support when women are fleeing domestic violence. This is a major issue that has had an impact on so many families and people. All Departments should work together to find solutions. Other speakers and I have said that we might ring one Department for one matter and have to ring another when something else arises. With Covid-19 and the time we are in, all Departments must work together. I am seeking extra funds for Women's Aid in Carlow and we must support all these services.

Some of the Deputy's comments fall outside my remit but I agree wholeheartedly with her comments on how so many young children have regressed and are finding it very difficult. It is very important that young children return to school. The Deputy knows the Minister for Education, Deputy Foley, and the Minister of State at the Department, Deputy Josepha Madigan, have been working really hard over the past two to three weeks with the educational partners, the schools and unions to try to facilitate a safe return to school. I am thankful we will have more good news in the next few days. Yesterday, for example, it was announced that there is a hope for a phased return to school from 1 March. We hope we can work towards that because we know that when children are in a routine, they have better structure and are better off.

I will share time with Deputy Michael Collins. There are many types of front-line workers and I draw attention to those front-line workers in the homelessness sector, where in many cases they work in a voluntary capacity. They are among the front-line worker heroes so I acknowledge and thank them for the work they do. This work is challenging at the best of times but especially now in times of Covid-19.

In Limerick we are very fortunate to have several voluntary organisations helping the homeless. For example, there is the Simon Communities, the Society of St. Vincent de Paul and Novas, which has been with us in Limerick since 2002. It also works in Clare, Tipperary, Kerry and Cork, and its goal is to bring humanity to this work. Everybody is entitled to a home.

Today, on 18 February 2021, more than 250 people are homeless in Limerick, of which approximately 150 are children. Those numbers are reflected throughout the country. Homelessness affects all strands of society and a commitment should be made to single persons, who amount to over 50% of people on the waiting list. Will the Government commit to delivering on its promise of 9,500 new social housing units in 2021? Targets can grab headlines but the reality is different. In January 2020, the Fianna Fáil leader and current Taoiseach, Deputy Micheál Martin, promised 100,000 social houses in five years of government. He is now the leader of the Government and has rowed back on the commitment of 20,000 homes per year to less than half that target, if that. If he is honest, it will not be met and we will come nowhere near it.

Isolation and boredom has really driven problems with gambling. In rural areas gardaí have witnessed a massive increase in drug-driving, which demonstrates our problems in targeting drugs. This is not just about young people as it concerns all ages. People are prosecuted for drug offences, including supply, and great work is done by the Criminal Assets Bureau. All the recovered money should go back to front-line services, including gardaí, to protect the next generation.

I am delighted to have the opportunity to speak on these matters, particularly the misuse of drugs and alcohol.

Many people are struggling during this blooming pandemic. Young people in particular are struggling. It has never been more important to make sure that treatment centres are open and are kept going. It is sad to note that in the short lifetime of this Government, the Cara Lodge residential treatment centre in Enniskeane has been closed. It was open for many years. I raised the issue with the Minister of State, Deputy Butler, who said it was an issue for the Minister of State, Deputy Feighan. I also raised the important question of trying to save the service with the Taoiseach on the floor of the House. Funnily enough, the Taoiseach opened the centre. He was quite willing to come down to open the centre, with all the razzmatazz that entailed, but when it came to saving the service, he was like a scalded cat escaping out of a skylight. I appreciate that the Minister of State, Deputy Feighan, did get back to me on the issue. He did explain that the service was not being used. It could easily have been saved. It was the only tier 4 service in Munster that was available. A different use could have been made of the centre. It was a fabulous place for those who used it. I read the comments from those who had used the service. They had their lives transformed. The staff who worked there did not just work with the patients, but also worked with the families. They tackled the issues and problems of the young people successfully, 99% of the time. Sadly, that service is now lost. It is easy to run down a service. There is no problem running down a service anywhere in the country. If it is planned a few years in advance the fences will be put up before there is any chance of survival.

The other situation arising out of this issue concerns jobs. In the letter he wrote in response to me, the Minister of State promised that the jobs that were there would be adequately looked after following the closure. That is not happening. That must be looked into. The staff cannot even get a reference to get another job. The centre provided 27 jobs all over west Cork. Obviously, there were other services feeding into it, but it amounted to 27 jobs in places from Skibereen, all the way back to Doorus, Clonakilty and Bandon. Those jobs are now gone. That these people have been treated in a such shoddy way is scandalous beyond belief. It was a trick to close the centre. The Taoiseach did nothing when I asked him about it. He said he would look into the matter, but I did not hear anything from him. The staff continue to be treated shoddily. The biggest loss was the loss of the centre for the young people of this country. It was the only tier 4 centre in Munster and it was closed under this Government. My belief is that people of south-west Cork are being punished by this Government. We no longer have the service that we had before.

Unfortunately, we cannot believe the homelessness statistics provided by the Government. We have known this since the previous Minister's days in charge of the Department. Figures were re-categorised to hide the real and distressing extent of the crisis. We know that the number of adults and children in domestic violence refuges and direct provision centres are not included in official homeless data, despite the fact that this type of accommodation is temporary and the housing crisis is exacerbating access to move-on options.

I have asked the Minister for Children, Equality, Disability, Integration and Youth to report how many adults and children are in domestic violence refuges in Donegal in each of the years from 2017 to date; to report the number of domestic violence refuge places in Donegal, compared to the recommended number of refuge places; the refuge capacity per county; and plans to increase access across the Island. I have also asked the Minister how many adults and children are in direct provision accommodation in Donegal in each of the years from 2017 to date.

We are due to have 60 new neighbours arriving in Letterkenny soon and I understand that there will be children with these families. I would like to see the families being empowered to shop in the local community and have agency and choice in where they use their food vouchers. It will help for a smoother integration into the local community. The direct provision centre in Letterkenny is self-catering and own-door accommodation, but it is still not secure and permanent housing.

Due to the lack of transparency around social housing waiting lists and homelessness data, I have requested information from the Minister of State's Department. I am looking for a full report on housing and homeless in Donegal, including the number of people who are on the rental accommodation scheme or in receipt of housing assistance payment, HAP. I am also seeking a report on the emergency homeless accommodation in the county, the number and demographics of those accessing this accommodation and the number of people on social housing waiting lists in the county, indicating the type of accommodation and the length of time they are waiting. Any figures supplied in respect of this request will be false, because those who earn over €25,000 per year cannot even get on the social housing list. They have no hope of providing themselves with housing. In Donegal, landlords do not want to be included in the HAP programme, so these people cannot access rented accommodation either. Therefore, there is a crisis right across the board that is affecting people there.

I have also asked about the level of funding provided to Donegal County Council for housing in recent years. This information should be readily available on the Government's website. Everybody should be able to access this information: policymakers, advocates, civil society organisations, Deputies, the media etc. Why is this information not easily accessible? It is important to ask that question.

Earlier this month, Linda Hayden, of the PAC Woman Podcast, held a live podcast panel discussion on the impact of homelessness on health. A theme of the podcast was the huge rise in women experiencing homelessness, particularly young women and Traveller women. Women experiencing homelessness are at increased risk of sexual and physical violence. Over 60% of families experiencing homelessness are single-parent families, usually headed by a woman. What female-specific policies are being implemented by the Minister of State's Department to address this growing trend? Another important point raised in the podcast was how bad consecutive governments have been in implementing strategies. Those in government all love a good photo opportunity and a glossy document, but not the actual implementation of strategies that will make tangible differences to people's lives. That is one of the areas in which this Government, and every government, is significantly lacking.

I have another question. When will people experiencing homelessness, and those working or volunteering in this area, receive their vaccinations? In the first wave of the pandemic, the organisations working with those experiencing homelessness were commended for the low number of cases in hostels and shared accommodation. People were given single rooms, where possible, and an improved type of accommodation for those experiencing homelessness was provided. If this can be done during a pandemic, why can it not be done outside of it? People with addiction issues are more likely to have underlying health conditions and therefore be more vulnerable to Covid-19. Vulnerable and marginalised groups should be prioritised in the allocation of vaccinations, right across the board, including those with underlying conditions.

I would like to commend the Irish Examiner journalists, Noel Baker, Ryan O'Rourke and Aoife Moore, for their work in bringing the names and human stories to the horrifying statistics of those dying on our streets. Some 79 people died in our homeless services and on our streets in 2020. That is just the official figure. I note that there has been a move to reduce that figure, because the Minister has said that it has not been reported properly. In the special report in the Irish Examiner, the faces and stories behind the deaths of homeless people were reported earlier this week. These three journalists brought some humanity to the victims. There was a report that the Minister of State is seeking to re-categorise homeless figures again. I suggest that it would make more sense for him to re-categorise his thinking on data. If he sees a homeless person on the street as he walks around town to his office or to get a coffee, he should look them in the eye and acknowledge them as he walks by. He should see them, look into their eyes as he passes them, and categorise them as a vulnerable human being with rights, a life, a history and hopefully a future. He can provide the future for them. The role of this Government is to ensure that that happens.

I thank the Deputy for raising this issue. Homelessness falls under the remit of the Department of Housing, Local Government and Heritage, but the Department of Health and the HSE are responsible for the delivery of a range of health-related services and supports for the homeless. Under health legislation, and the Health Act 1953 in particular, the HSE has a statutory obligation towards homeless persons. This is understood to mean that it has a responsibility in respect of the homeless.

Together with the Minister for Health, I met with the Minister for Housing, Local Government and Heritage, to agree how dedicated funding and resources can be provided to deliver the necessary health and mental supports required to assist homeless people with complex needs. Within my remit as Minister of State at the Department of Health, I have made the health needs of homeless persons a key priority.

As the Deputy rightly stated, there are addiction and mental health issues among young people. This is a matter of particular concern to me.

In respect of the vaccination of vulnerable and homeless people, I have engaged with those rolling out the vaccination programme, to ensure that people with addiction issues, the homeless and marginalised are included in the priority groups. I have also highlighted that those who attend addiction services, live in homeless accommodation or are regarded as vulnerable, should fall under certain groups. The Deputy is absolutely correct. We cannot be complacent about the on-paper prioritisation of these vulnerable groups, because there may be unintended barriers to equal access to the vaccines. These barriers could include difficulties in attending designated vaccination centres, a lack of contact with and trust in the health services, vaccine hesitancy due to lack of information and low levels of literacy or language barriers. I am aware of those issues. The vaccination table is a living document. The vaccinations will be taking place over weeks and months and NIAC, NPHET and the HSE will be looking at various cohorts who have not been left out, as such, but where there may be a need to see what criteria they fit into. I thank the Deputy for raising that issue.

Sitting suspended at 11.51 a.m. and resumed at 12 noon.