Ceisteanna ó Cheannairí - Leaders' Questions

Before I begin, I offer my condolences to the family and friends of Máire Mhac an tSaoi, Brendan Kennelly, Paddy Moloney and Tony MacMahon, all pillars of Irish arts and culture for so many years. Their deaths are a huge loss to us all, or as Theo Dorgan - the Taoiseach is aware he is an another Corkman - so eloquently put it, we are so much poorer for their absence and so much richer for their lives and for their work.

Today, the Cabinet has announced plans for further easing of restrictions. Covid is a horrendous virus and it is still with us. Thankfully, our population is largely vaccinated and this should allow us to proceed safely back to normal, but our healthcare capacity leaves us vulnerable. The crisis that we face now is a hospital bed and capacity crisis. Science has done its bit, medical professionals have done more than their bit, but the Government has failed to step up.

Here are the facts. Hospitals across the State are seeing record levels of overcrowding. Emergency departments are overflowing. The trolley count is rising. It is 416 today. Health waiting lists now stand at almost 1 million waiting for care, and almost a quarter of a million of those have been waiting for more than 18 months. Yet, in the face of this crisis, and increasing Covid numbers, the response of the Government in the budget was not one single additional inpatient bed. Not one. How are we to make it through the winter? How will burnt-out, front-line workers cope? How will the health service survive? The Government's approach means that for the remainder of this year and the entirety of next year, we will have no additional inpatient hospital beds. Is the Taoiseach seriously suggesting that no additional inpatient beds are needed until 2023?

The crisis is now, the overcrowding is happening now, the trolley count rises now and waiting lists are growing. Phil Ní Sheaghdha of the INMO has said of our hospitals: “They cannot cope today, they won't be coping tonight and they won't be coping tomorrow." This is a very stark warning and the Taoiseach needs to listen.

None of this has come out of the blue. The Taoiseach has to have known that this crisis would hit our hospitals hard in the wintertime. Indeed, last July, Sinn Féin and our colleague, Deputy David Cullinane, called for planning for the winter to start then. We urged the Government to prepare for what was to come. We called for an additional 600 inpatient beds and the recruitment of staff to service those beds and we repeated that call in our budget. The Taoiseach chooses to ignore those calls. He chooses not to properly invest in and resource our hospitals, and that leaves us exposed again. So, now, the chickens come home to roost, and it is patients, hospital staff and wider society who pay the heavy price. Tá ár n-ospidéil faoi bhrú ollmhór. Ní féidir leo déileáil leis an mbrú sin. Caithfidh an Rialtas infheistíocht a dhéanamh iontu anois.

I want the Taoiseach to change direction immediately. I am calling on him to do that. I want him to provide the investment needed, increase the number of beds in our hospitals, relieve the overcrowding and lift the intense, unbearable pressure on front-line staff, who are now beyond breaking point. This must be a central plank in the Government's response to the Covid-19 crisis.

I thank the Deputy for raising the issue. I also join the House in expressing our sympathies to the families of the late Máire Mhac an tSaoi - b'fhile den scoth í a rinne an-chuid ar son ár dteanga dhúchais - Brendan Kennelly, Paddy Moloney and Tony MacMahon, artists and musicians who enriched our lives in a wonderful way.

I think the fundamental premise of the Deputy’s question is wrong. The driver of our responses over the last two years in terms of health, and public health in particular, has been the Covid virus itself and the various mutations. The Alpha mutation earlier this year had a devastating impact on us. Likewise, now, the Delta variant is even more transmissible than the Alpha variant, and it has had a very significant impact globally and in this country in terms of the incidence of cases in terms of hospitalisation, ICU admissions and mortality.

Thankfully, because of vaccination and a very effective, efficient and well-run vaccination programme, we have achieved up to 93% vaccination. The vaccines are very effective in preventing severe illness, hospitalisation and admission to ICU, and in terms of mortality and preventing death. However, over time, in terms of protecting against infection itself, it is not as strong as it would be in terms of the cases I have just outlined. Therefore, there is a need for a booster campaign. That was the key recommendation from NIAC yesterday, which the Government will implement immediately. It will be the administration of the booster vaccine to the over-60s which will help us in holding back the impact of Covid.

In respect of hospital beds, close to 938 beds are due to be delivered by the end of this year. The Deputy has ignored completely in her presentation the fact that well over 900 beds have been budgeted for and have been provided for, with the follow-through provided for this year in terms of the staffing, for example. That was the largest bed increase ever in one year in terms of hospital capacity. Likewise, in terms of ICU, again, there has been a substantial 25% increase in ICU beds over the last two years. It is close to 300 now and it will get to 321 by the end of this year or, at the latest, very early next year. These are very substantial increases both in ICU and bed capacity.

The situation as advised to us by NPHET is that, in all age groups now, people are getting infected. While we are reopening, we are doing so in a very cautious way, with the vaccination certificate at the heart of the protective measures that need to be taken.

The Deputy opposed tooth and nail the vaccination certificate provisions that were introduced the previous time in this House to facilitate access to hospitality. She and her colleagues very strongly opposed that, yet it was the key to opening hospitality and it was advised by NPHET that this was what we should do. NPHET is now advising the same in respect of the remaining elements of hospitality. Conscious of the growth in incidence levels, it is very anxious that, where practical, appropriate and where it makes sense, a range of protective measures be introduced, the most critical being that the vaccination certificate be applied across the board, together with due diligence by operators and consumers. That is the key issue. We will be increasing staff in the health service by another 8,000 this year. There is going to be no let-up in the investment.

Covid is a terrible virus and sickness, and it is with us to stay. The level of vaccination, at more than 90%, is extremely high. As I said, science has done its job and the medical professionals have done theirs. The Government now needs to do its job. The fact is that the lack of capacity within our health service leaves us vulnerable still. It means there is a panic right across society when infection levels, hospitalisations and ICU admissions rise. That is all down to capacity.

I put it to the Taoiseach that the Government did not make additional provision for as much as one new inpatient bed in the budget. That is a fact. Provision was made for 19 new ICU beds, but that is a drop in the ocean. Everybody knows that at the heart of our dilemma, with a highly vaccinated population and people doing their best and being very thoughtful and cautious, we are still left with this huge vulnerability in terms of healthcare and hospital capacity. The professionals are telling the Taoiseach this. He knows this; it is not just me saying it.

Thank you, Deputy.

I want to know how the Government will address that, how we will get through the winter-----

The Tánaiste to respond. Gabh mo leithscéal. The Taoiseach to respond.

-----and how hospital capacity will be supplemented.

An increase in the number of ICU beds from 255 to 321 by the end of this year is not a drop in the ocean. If the Deputy knows anything at all about ICU beds, it is not about the beds themselves but the entire staffing team that goes behind them.

You are just playing with numbers.

The number will be up to 340 by the end of 2022. That is an enormous increase in ICU beds over a very short period of time. In addition, as I said earlier, well over 900 beds will be provided.

Are you are saying we have enough?

What we did last year - in the funding we provided for the winter initiative, which got us through last winter - was we provided two-year funding to enable the staff to be recruited and the beds to be provided, so we would not have the annual struggle that went on between Departments in respect of getting annual allocations. That has been very effective.

No, it has not. You are playing with the numbers.

However, other measures have to take place, of course, in respect of diagnostics and other measures in terms of home care and so on to make sure, as far as we possibly can, that there is a very good, efficient flow through our hospitals.

Thank you, Taoiseach.

I want to make a final point. The issue about the increasing numbers is not about hospital beds alone, although that is important. It is about individuals. We want to protect individuals and that is why protective measures are needed from severe illness and so on.

Hospital beds are the issue.

(Interruptions).

We are over time. Táim ag bogadh ar aghaidh.

I join with the sympathies and sentiments that have been expressed on the deaths of Máire Mhac an tSaoi, Brendan Kennelly, Paddy Moloney and Tony MacMahon.

The announcement today on the lifting of the restrictions was yet another startling display of confusion, coherence and chaos from the Government. With just three days to go before many businesses that have been closed for nearly two years are due to open, the rules are being rewritten. We all accept that the rates of Covid transmission can surge very quickly and can be unpredictable. What is predictable, however, is that we know without a shadow of doubt how the disease is spread. It is airborne. Businesses have been given absolutely no guidance on the manner in which they can improve ventilation and make their premises safer. Air filtration units, for example, could be rolled out to schools for as little as €12 million, but they have not been issued. Nightclub and music venue owners are going to get advice at the last possible moment on how they can open their businesses.

All indoor businesses where people congregate should have been given guidance on ventilation months ago.

The Taoiseach said yesterday that he is a great fan of antigen testing and that came as a surprise to many of us because there is no evidence that anyone in government is a fan of such testing. We are told that the continued reopening is to a large extent contingent on antigen testing being rolled out to scale. Why was that not done before? How will this massive surge in the use of antigen testing work, given that almost zero prior planning has been done for that?

We are told that people can dance in nightclubs, for example, but that they cannot go to the bar for a drink. It is confusing; people could probably dance to the bar. In his address earlier the Taoiseach attempted to defray the blame by talking about personal responsibility. Irish people have been brilliant in what they have done and we would all agree on that. They got vaccinated in their droves and stayed at home when they were told to do so. There are other issues of planning at play and we have always been in an emergency. There is also the issue of the creaking hospital capacity. We are 20 months into the disaster and there is a modest target of an increase of 66 ICU beds this year. That target has not been met and there has been no mention of additional capacity in this year's budget.

Would the Taoiseach accept that there has been a failure to plan and that we are back at an emergency stage in the opening of businesses and the criteria being applied? There has been a failure to accept that this is an airborne virus. The ads that are being shown at the moment instruct people to wash their hands. The evidence is not that the virus is transmitted by touch but that it is an airborne virus. Why has the necessary attention not been placed on that?

Every debate we have when restrictions come in or go out is the same. I recall a debate in the Dáil before the summer on the measure that enabled us to open hospitality, namely, the vaccination service. It was a heated debate with Members opposite saying it was the worst thing we could possibly do, yet it enabled the reopening of hospitality, including restaurants and pubs. Has anybody on the Opposition side said we got that wrong or have they said they were confused or that they gave an incoherent message? The Opposition always tries to pick holes although I acknowledge that there are difficulties and challenges, particularly for the sectors concerned.

Covid does not respect weekly decision-making on a precision basis. In our conversations with public health officials two weeks ago, this scenario was not on the horizon. The case numbers have taken a turn for the worse and we have to respond. It is as simple as that. We could have decided to pause everything and not open anything afresh. NPHET stated that it:

Did not believe it tenable that any pause now would result in a further easing of measures in November. The NPHET has therefore recommended that on balance:

... the remaining aspects of the hospitality, entertainment and night-time economy sector can reopen only with the full range of protective measures in place and the wide and robust implementation of the COVID-19 pass. In this regard, guidance should be developed or updated as appropriate by the relevant sectors.

NPHET goes on to list all the various measures and uses the phrase, "including the appropriate use of masks, physical distancing, ventilation, and mitigation measures". That is what is in NPHET's letter and it is now saying it does not see those measures being removed until February 2022. The measures must be implemented where appropriate and there has to be practical application of this in different settings.

Members will raise all the anomalies and ask why one thing can be done in one setting and another thing cannot be done in another setting. Those anomalies will arise in scenarios like this but the key point is that anything we have reopened so far has stayed open. Despite what some lobbies are saying, these restrictions have not inhibited a lot of activity because the Revenue and the VAT receipts are showing that a lot is going on in many sectors because of the reopening of society and the economy. It is better to try to proceed with reopening, albeit with restrictions that people will find frustrating.

It is because of the virus's turn for the worse that there is a timeline problem for the sector. I acknowledge that and the need for guidance and the need to engage with the sector and to do practical, sensible things to enable reopening and to enable the facilitation of plans that sectors that up to now had been closed have in place. We have got to work with sectors to do that. The same applies to the return to work. The Labour Employer Economic Forum, LEEF, which has employer representatives and union representatives, is meeting today to discuss that whole area in terms of the return to work on a safe basis.

I wish to raise the issue of this virus being airborne. An expert committee was in place but nothing seemed to come from it in terms of advice. We know that the virus is airborne. What guidance has been given to the sectors that remain closed and what guidance does the Taoiseach anticipate the Government will give them or will it be exclusively for them to find out for themselves? We all accept that it is late in the day and people are saying that they need some degree of certainty. I listened to an advertisement during the week that was still talking about washing hands and wearing masks, but it did not give guidance about the virus being airborne even though we know that that is where it is spread. Clearly, we cannot put all of our eggs in the vaccination basket. As such, we must address the central point of where the virus is spread. What is the Government doing in that regard, particularly in respect of congregated settings, for example, schools, nightclubs and music venues? What guidance has been given on, for example, units that people can simply plug in?

The Deputy has made a very true statement there, in that we cannot put all of the eggs in the vaccination basket alone. In fact, that is what the Chief Medical Officer, CMO, said to us last evening. He made that very point. Vaccination is a game changer, of course, but we need additional non-pharmaceutical protections to be in play as well to keep the virus at bay, particularly during the winter season because there could be a seasonality factor. In our climate, we tend to be indoors more during the winter period in terms of socialisation and so forth. I take that point.

On ventilation guidance, documents have been prepared and have issued. In respect of schools, for example, CO2 monitors have been sent to schools across the length and breadth of the country. That is the recommendation that they received in terms of how they should operate proper ventilation policy in primary and second level schools.

The development of sectoral guidance is not something new. It is something that has been ongoing since the commencement of the pandemic itself. It is something that can be achieved, working with the representative organisations in a given sector and Departments, including the relevant Department.

At the weekend, Mr. Killian Woods in the Business Post revealed that the National Asset Management Agency, NAMA, was in possession of 54 units - let us call them what they are, namely, potential homes - in Prospect Hill, Finglas, 28 of which were vacant and 26 of which had been empty for a decade. That is an incredible fact for a publicly owned agency. This report confirmed and provided further detail on information that I had received in reply to a parliamentary question recently. When it is all added together, the situation is even more shocking and disgraceful. NAMA is still in possession of 577 acres of residential land that is suitable for delivering housing. In the answer to my question, it was confirmed that NAMA was in possession of 50 units that were sitting vacant and that it also had 1,400 units under construction, 4,600 units with planning permission, 7,500 where planning applications had been submitted or were in preparation, and 8,500 units at pre-planning stage. NAMA has the land as well as assets that are well under way to deliver 24,000 homes, but what is it doing with them? It is selling them at prices in excess of €500,000.

The agency is selling them to vulture funds and cuckoo funds, that is, property speculators and the very people who are driving rents to unaffordable levels and house prices to completely unaffordable levels for the vast majority of working people. When questioned about this recently, Brendan McDonagh confirmed that NAMA does not sell properties unless it can yield a profit from them. Is the Government not speaking out of both sides of its mouth when it says it is doing absolutely everything it can to address the housing crisis and to deliver public and affordable housing while at the same time an agency, fully in the control of the State, which has paid off all of its debts and has €1.2 billion in cash reserves having sold €42 billion worth of property and assets, mostly to the same vulture funds and cuckoo funds, is not being used to deliver every house or residential unit that it is capable of delivering for public and affordable housing only? How can the Government possibly allow a situation where a public agency is contributing to the housing crisis, is facilitating the property developers and, in some cases, as also confirmed in the response to the parliamentary question, is selling houses to these property investors who then lease them back to the local authorities, for which the Government is paying astronomical amounts of public money to these entities? Is that not outrageous? Will the Government issue an instruction to NAMA, as it can do under the Finance Acts, to deliver everything it has as public and affordable housing and to stop its actions which are contributing to the housing crisis?

That instruction cannot be issued in the manner articulated by the Deputy and he knows that well. The legislation underpinning NAMA is very specific. That Act sets specific objectives and functions for NAMA, which are well established. NAMA has facilitated the construction of housing. There is an issue in terms of how, going forward, we interact with NAMA in regard to the provision of social housing. NAMA has in the past offered social housing to the State through the local authorities and so forth, some of which was taken up by local authorities and some of which was not taken up because of the local authorities' views in terms of the suitability of the particular housing that might have been offered by NAMA at that time.

The Housing for All strategy commits approximately €4 billion per annum by the State. The State is phasing out the leasing of units. The overwhelming majority of the State investment under Housing for All is going into the construction of housing, particularly social housing, at approximately 9,000 units per annum. There will be some element of purchase and, for the first two years, the phasing out of the leasing of local authority housing to deal with homelessness and people who are in need. Let us not sloganise a completely wrong narrative in terms of the State's centrality in building social housing and in facilitating the building of affordable homes and providing the infrastructure to enable house construction to happen, be that water infrastructure or the urban regeneration and development funds, URDFs, which have been announced all over the country to facilitate brownfield sites and the development of compact housing and apartment construction. That is the agenda. It is a State-centred approach.

In respect of NAMA, it has very specific legislative underpinning. There is an issue in regard to how, as time evolves, we interact with NAMA in terms of using its capacity to add to the State's endeavours under Housing for All in terms of the provision of housing. That will be under ongoing review.

The Taoiseach is misleading people. He is correct that the mandate set by the Government for NAMA is to blame for this outrageous situation. Let us remember what is at stake here: thousands of families are homeless, almost 100,000 families are on housing waiting lists and 70% of working people are completely priced out of the housing market.

The truth is the NAMA legislation first of all requires the agency to avoid undue concentrations or distortions in the market for development land and to have regard to proper planning and sustainable development land and it gives the Minister the power to confer on NAMA, by order, additional functions. It also has a requirement to contribute to the social and economic development of the State. The power is there. It is in the hands of the Government to tell NAMA what to do with its remaining housing and land assets. The Government refuses to tell NAMA to deliver all it can, namely, 24,000 homes, which would contribute enormously to alleviating the housing crisis. It refuses also to tell the agency that it must deliver all that as exclusively public and genuinely affordable housing, instead of what it is currently doing, which is selling it to profit-hungry investors who are driving the price of property and rent through the roof and contributing to the housing crisis.

NAMA represents the taxpayer. It had a responsibility, with regard to the loans it took over, to yield a return for the taxpayer, whom this Oireachtas represents. As I said earlier, NAMA has offered housing stock to local authorities already. As I said, in the coming period, the utilisation of NAMA's activities in respect of further housing provision is something that is under ongoing review by Government, and it will remain under review. However, we need more houses and we need more houses of different types.

We do not need houses at €500,000.

We are providing social housing.

Remarks should be made through the Chair.

We are not doing it at €500,000. The State is going to build-----

NAMA is. It is also sitting on empty properties.

The State is going to build social housing. We will provide 11,000 social homes in 2022. That is what we are going to do. We are going to do an average build of about 9,000 every year. In addition the State is going to build and help to facilitate the building of a whole range of affordable houses, and cost rental ones also.

As a historian, long before he became our Taoiseach, the Taoiseach must have thought about what his enduring legacy might be. I used to think the oft-quoted Fianna Fáil reflection on Government as "senior hurling" was about political competition, the training and effort taken, the resilience and gumption required and the skill of our national sport, not that our Cabinet members tog out in their individual county jerseys. The mean-spirited question I have for the Taoiseach, for which I apologise in advance, is whether he is a Cork Taoiseach or a Taoiseach who just happens to be from Cork.

I ask this grim but important question because we are now half way into his term as Taoiseach and in that time we have seen two budgets and the revised national development plan. I remind the Taoiseach of a pre-election promise he made to the people of the south east in 2016. He promised to provide 24-7 cardiac care to the south east region. That year he stood for a picture on the grounds of University Hospital Waterford, UHW, with his candidate and all his Fianna Fáil councillors and committed to delivering 24-7 services. That picture was at the centre of the Taoiseach's 2016 campaign. It was the photo that restored a seat to his party in Waterford. The Taoiseach did not stand and promise another study, review or investigation. He deliberately stood on the grounds of UHW and committed to deliver a long-promised life-saving service and one which is available to people in every region of the country except those of us in the south east.

In the preceding general election of 2011, Enda Kenny pledged the south east a full university and with that promise he took half of the seats in the region, that is, seven out of 14. However, in power, he resiled from that promise. His party, Fine Gael, now has just two of those 14 seats while we in the region were left pick up the massive economic and social costs of that lost decade. This is heartbreaking when we see Grangegorman springing to life.

At this point in time, the Taoiseach's legacy in the south east is from his time as Minister for Education when, under pressure from Cork, he undid the institute of technology upgrade in 1997.

In the south-east region and in Waterford, Enda Kenny's legacy is entirely framed by his unkept promise, his broken word. I have a simple question for the Taoiseach. Will there be a 24-7 cardiac care service, a service available in every other region in Ireland, in the south east before he leaves the Taoiseach's office? Will he be keeping his promise?

When I was a history student, the first thing I was told was that one should always endeavour to be objective in terms of one's historical narrative, to try to see all sides of the story and the equation and not to view things through the prism of one's own narrow perspective or partisan view of things. I recall that when I was the Minister for Education and Science, many of the institutes of technology or the then regional technical colleges were looking for status upgrades and so on. I recall looking at the plant, at the actual buildings, and saying that it would be better to invest substantially in the capacity of the colleges. My legacy in Waterford was buying the additional land which has guaranteed, since the late 1990s, the very significant expansion of Waterford Institute of Technology to such an extent that, under international peer review, it can compete to be a university and will become a technological university. That is the way universities should become universities. It should not be at the whim of politicians arriving at some platform and announcing that they are going to make a body into a university, with no regard for capacity or a whole range of investments that should happen in advance. That is the approach I took as Minister for Education and Science. We had a binary system but we set up a peer review and have provided for technological universities to happen. Successive Ministers have progressed the idea of developing institutes of technology into technological universities and doing so in a way that is fair and that has credibility internationally. When it has credibility internationally, the region benefits in terms of more investment. The Waterford Institute of Technology has really advanced over the last decade or two and has developed significant specialties, not least in the areas of enterprise and industry and quite a number of foreign direct investments have occurred as a result of that.

I would say that the time has come to talk up Waterford and its third level institution because it has a lot to commend itself. That is what I would do. I have great belief in that institute and I believe that along with Carlow Institute of Technology, it is going to become a technological university, which is great for the region. We are committed to doing that and to the consequential investments that will be required of the Minister for Further and Higher Education, Research, Innovation and Science, Deputy Harris.

In respect of the hospital, Deputy Shanahan's constituency colleague, the Minister of State at the Department of Health, Deputy Butler, has been tenacious and alongside the Deputy and others, is determined to advance the situation with regard to the cath lab and cardiac cover. The programme for Government commits to the delivery of a second cath lab in University Hospital Waterford. Funding has been allocated and the contractor for the construction of the new lab was formally appointed in March. The project commenced in May of this year, with a work programme of around 13 months. The equipping and staffing of the lab is provided for and will happen.

The Taoiseach has spectacularly failed to answer the question I asked. What I take from that is that his hard answer is "No" and that he will leave office in December 2022, in 14 months, without that promise to the people of the south east being kept. Other promises in the programme for Government are being kept, despite the incredible challenges of Covid but if the Taoiseach's promise on 24/7 cardiac care for the south east is not kept then politics in this country is broken, frankly. There are huge swaths of the country that feel unrepresented by the current Cork-Dublin Cabinet. Reasonable and necessary things, life-saving things like 24/7 cardiac care in the south east, are not being delivered and cannot get done. The Taoiseach is halfway into his term at this stage but he still has time if he decides to take action. His legacy and possibly that of his party in the south east will be the promises made on the cardiac issue to stoke up political support and whether the Taoiseach is a man of his word and will deliver on them.

We are going to dramatically expand cardiac provision as Deputy Shanahan knows. It is provided for and-----

What about 24-7 services?

We need to get the second cath lab built and staffed.

That is how to progress it and get a 24-hour service. You have to progress it. The Deputy knows that at this stage-----

Make the commitment. We want to see the commitment.

------through all the deliberations that we have been through. University Hospital Waterford is commencing the recruitment of the required staff right now for the second catheterisation lab in the coming months. That is a massive improvement. The Deputy knows the arrangement for intervention cardiology and diagnostic elective procedures between UHW and UPMC in Waterford and the service-level agreement that has been arrived at. He also knows that for the North Quays, the largest ever investment by a government in Waterford was announced and committed to.

We are speaking about the hospital, not the North Quays.

The Deputy is talking about and creating a narrative of partisan investment in different parts of the country. There is huge investment committed to, announced and allocated to Waterford in terms of the physical infrastructure of the North Quays, investment in the hospital and the new technological university, which will be very beneficial to the region.