Ceisteanna ó Cheannairí - Leaders' Questions

The first question today comes from the acting leader of Sinn Féin, Deputy Cullinane.

That is quite an elevation. Hospitals are at breaking point. Several have already begun cancelling scheduled care to cope with overflows from record emergency department admissions. Yesterday morning, more than 515 patients were admitted to hospital without a bed. They were left on trolleys or chairs in ward corners, corridors and waiting rooms. Last week, more than 1,800 patients were languishing on hospital trolleys. The Saolta University Health Care Group, which serves the north-west and west regions, is worst affected, along with Limerick, Cork and Waterford university hospitals.

The cancellation of elective and often time-sensitive care is unsustainable. It will lead to the worsening of conditions, physical health and mental well-being. Last month, the chief executive officer of the University Limerick Hospitals Group stated that the Irish Patients Association is quite right to point out that significant reductions in scheduled care are not sustainable in the long term.

The truth is that we need more staff and capacity in public hospitals but this Government and the previous Government have failed to deliver.

Consequently, many healthcare staff are considering leaving the service. They tell me that all the time. It does not give them any pleasure to do so, but they say it is because they do not feel valued or respected and they are burnt out. Day in, day out, healthcare workers are dealing with crisis after crisis on the front line. They forgo lunch and annual leave because they know that if they take such breaks, they will heap more pressure on their colleagues and cause patients to suffer. This level of moral injury is unsustainable and unacceptable. The Tánaiste will have seen recently front-line nurses have been protesting outside some hospitals because of unsafe staffing levels. What is the Government's plan to address the appalling working conditions to help retain our highly skilled healthcare workers?

I am also hoping the Tánaiste can confirm the Government's intention to address the issues raised by student nurses and midwives, who are again protesting outside the Dáil today. They should not have to protest. It is disgraceful that people who are trying to do their best in our health services have to come to the Dáil to protest to get the Minister for Health to act on what has been a running sore and a long-running issue, namely, fair pay and allowances for student nurses and midwives. A temporary pandemic payment was put in place at the end of this academic year, but we need a permanent solution. That means a permanent solution for fourth years and for first, second and third years.

I am shocked, but not surprised, that the Irish Nurses and Midwives Organisation, INMO, and, indeed, other healthcare trade unions learned of the changes to the intern pay rates in The Irish Times this morning, like everyone else. This is an industrial relations issue; they should not have to wait to read it in the newspapers. There should have been discussions with the public health trade unions, and yet that is not what happened.

What is happening is unacceptable. Student nurses are telling me in their droves, and I have met many student nurses and midwives over the course of the past year, that they want to work in our public health services and be part of ensuring we deliver the best, world-class healthcare services we all want. However, if they do not feel valued and respected, they are going to leave. We need to recruit and retain more nurses.

When will the McHugh review be published to give clarity on its recommendations? Will there be discussions and negotiations with the Irish Nurses and Midwives Organisation and other healthcare trade unions so that fair pay and allowances can be put in place for student nurses and midwives?

I thank the Deputy. For many in society, when it comes to the pandemic, things are largely back to normal. Many people are able to go back to their workplaces and schools, colleges, shops and businesses are open. For our hospitals, however, the pandemic is as bad as it ever was. There are 500 people in hospital with Covid today and almost 100 people in ICU. Hospitals are trying to manage Covid care as well as regular healthcare, and there is a big backlog of unmet need, given that non-Covid care was reduced so much during the initial phase of the pandemic. Therefore, hospitals are very busy at the moment. People in our hospitals and across our health service are working extremely hard. We are facing into a very busy winter as we try to manage the pandemic, provide regular care and address the unmet needs of those whose healthcare needs were not met during the pandemic. We acknowledge the extraordinary work of all our health service workers in that regard.

On the issue of student nurses, which I am aware the Deputy has raised and has a real interest in, it is the Government's policy to protect and support the continued education of all students, including student nurses and midwives. A longer term review of matters related to student nurse and midwife allowances and internship pay has been conducted by Mr. Sean McHugh. I am advised the Minister for Health, Deputy Donnelly, will outline his plans regarding the report shortly, and these plans include a 12.5% increase in payments to student nurses and midwives in their internship year and a continuation of the pandemic placement grant. Payments may be required to be backdated to October.

While they are on their clinical placements, student nurses and midwives in years 1, 2 and 3 and in the first semester of year 4 continue to receive a weekly accommodation allowance of €50.79 as well as reimbursement of their travel costs.

Supernumerary student nurses and midwives also received an additional and exceptional pandemic placement grant during the academic year of 2020 to 2021. This was designed to support them with undertaking clinical placements during the pandemic. As the pandemic is still continuing and staff in hospitals face particular challenges, the pandemic placement grant will continue to be paid. The Minister for Health will announce details of this shortly. The pandemic placement grant was introduced by the Minister as an exceptional payment to support students attending clinical placements during the last academic year. As the pandemic is still ongoing and staff in hospitals continue to face particular challenges, this grant will continue to be paid. The Minister, Deputy Donnelly, will announce further details as soon as possible.

We will have to wait and see exactly what is in the memo the Minister brings to Cabinet. The reality is there have been three meetings between the Irish Nurses and Midwives Organisation and the HSE. This is an industrial relations issue, and yet that healthcare trade union and those student nurses and midwives outside the Dáil had to read in a newspaper what may or may not be in the memo. I ask the Tánaiste directly whether there will be engagement with the Irish Nurses and Midwives Organisation on precisely what is in the memo.

The Tánaiste has outlined what might be in place for first, second and third years. It is unacceptable. This is an emergency pandemic payment of €100 which many of them said fell far short. There is no sense this will be permanent. There is no sense any permanent solution is being put in place for first, second and third years.

I do not believe the Tánaiste gets it. If he were outside today, like many of us were, speaking to those student nurses and midwives they are telling us directly, and it does not give me any pleasure to say this, that they do not feel valued and that the first chance they get they will be gone. Let us avoid them going. Let us treat them fairly and with respect.

Will the Tánaiste also explain when the recognition payment that was promised for those on the front line and in healthcare will be paid? We heard about it before the budget and during the budget. There was a lot of talk about this exceptional payment for those on the front line in healthcare. We have heard nothing since.

I thank the Deputy. There will, of course, be engagement between the Minister and the HSE on one hand and the Irish Nurses and Midwives Organisation and SIPTU health on the other on this issue of student nurses and student midwives which, as the Deputy said, is an industrial relations issue. It is appropriate there should be further engagement. I do not know when the Minister, Deputy Donnelly, will formally bring a proposal to Cabinet, but there is Cabinet meeting on Thursday and one again next Tuesday, so I imagine it will be quite soon.

The proposals being made in the report provide for a 12.5% increase in the payment to student nurses and student midwives in their internship year and the continuation of the pandemic placement grant, recognising that the pandemic is ongoing. This may need to involve some back payments also.

It is worth pointing out the only healthcare students paid salaries are student nurses and midwives in their fourth year. They are paid between €21,000 and €22,000 on an annualised basis. During the 36-week internship in fourth year they are counted as point 5 full-time equivalent staff as they have not yet qualified.

In terms of recruitment in the round, it is worth acknowledging we have a budget of €22 billion. This is 50% higher than it was only six or seven years ago. On a per capita basis it is probably one of the highest in the world. The HSE has recruited 7,000 or 8,000 additional staff since the pandemic. It has authorisation to recruit a similar number again on top of this. It is doing a good job in recruiting as many staff as possible, notwithstanding the fact we face recruitment and retention challenges that are a feature of all health services.

I have been studying health for many years. It is the reason I got into politics. I do not think we realise what we are facing into over the coming months. I am not saying this in any political way but genuinely. I have never seen so many people, and I have family members who work in the healthcare area, who are so exhausted. They are facing into a perfect storm because of where we are with Covid. We do not know where we are fully going there. This winter will not be like last winter because we will have other issues such as the flu. It is a perfect storm. This year they are absolutely exhausted - completely exhausted. Last year we rallied but this year I am not sure whether rallying will be enough.

The trolley watch figures given out by the INMO are so disturbing. University Hospital Limerick, UHL, is my nearest category 1 hospital and I have never seen the figures like these, with 75 people on trolleys. I have never heard the kind of stories I am hearing from University Hospital Kerry, and I know many people working in both hospitals.

Where is the winter plan? It was released last year in September; it is now November. The Tánaiste will obviously have a date for it in return to my question. We also know that the efficacy of the of Covid-19 vaccines is dropping and all international studies are showing that.

What are we doing on clean air quality? Ventilation is probably the issue that has been most underassessed and utilised as regards combating Covid-19 because it is an airborne disease. Do we have a regulatory proposal for the winter months regarding ventilation and clean air across all workplaces as people come back to work?

I welcome that the National Immunisation Advisory Council, NIAC, which did not meet for more than two weeks, incredibly, is finally allowing for booster shots for the 340,000 healthcare workers. I presume it will be all health care workers, It will be done in about three weeks because we have the infrastructure in place. That was good planning.

There are, however, a number of other issues we need to deal with on top of that. I have said for a month now we need serial testing in nursing homes. There have been 12 outbreaks in the last week. We need to just learn from the past and not blame anyone. For a period over the winter months we need serial testing in nursing homes to protect our most vulnerable there.

I agree with the previous speaker on student nurses. This report should be with the student nursing unions before it is leaked to the media once again. It is scandalous that happened. There should be proper interaction so what is being proposed can be negotiated with them and can be told to their faces.

I thank the Deputy for his questions. Nobody knows for sure what we are going to face into this winter with the health service. Much of that will depend on the pandemic and on whether cases peak and fall, continue to rise, or level off at a certain point. Looking around Europe and at other parts of the world, it is hard to know for sure what trajectory we are going to follow. We will respond to it in a strategic and nimble way.

What is clear is that our health service, our hospitals and our primary care are going to be very busy this winter. They are busy every winter but this winter is going to be as busy as any we have seen in the past and perhaps more so and the system will be under pressure. That is because of three things: the impact of the pandemic, which is ongoing; regular health care needs which have not stopped; and a significant backlog of unmet health care need because certain services were curtailed or shut altogether in the early stages of the pandemic.

We are doing a number of things. Phenomenal additional resources - €22 billion - are being spent this year in the health service. That extra €4 billion that the health service had in a previous year is being retained. The health service is receiving more funding in 2022 than many Opposition parties even called for. There are an extra 850 beds in the system, above where we were when the pandemic began, and more can be added. There is additional intensive care unit, ICU capacity and more funding for community care, home care, general practice and for the use of private hospitals, as appropriate and as needed, under the existing agreement. These are all the tools we can use at the moment to manage the situation.

The second aspect is the vaccine booster programme, beginning this week for all of those between 60 and 80 and is already under way for people under 60 who are immunocompromised. The next group that has been approved is healthcare workers, and I believe this can be done very swiftly. I welcome NIAC's decision in that regard. NIAC will next consider people under 60 who have chronic conditions and who may well also need the booster shot. There is very good evidence from other jurisdictions, including Israel, the country first vaccinated and first boosted, that the booster shots are very effective. We are going to see an extensive booster programme and all of us in this House have called for that.

On ventilation, there is advice in the Work Safely Protocol which is agreed between Government, unions and employers, and that is updated regularly. Serial testing in nursing homes and the extension of antigen testing to schools are under review by NPHET.

The 60- to 69-year-olds are a group I have raised many times in the House in regard to the length of time they had to wait for their second vaccine. They now have to wait another five to six months to get their boosters because they were in the category that received AstraZeneca. What comfort can the Tánaiste give people in that category, as everyone else gets boosters over the next three weeks, regarding the efficacy of their vaccines and how the boosters that are given to them will not discriminate because of their being in that category?

Second, I am all for COVAX and distributing some of our vaccines to poorer nations across the world, particularly the vector vaccines. However, the mRNA vaccines are not really distributable to poorer nations because they do not have the infrastructure. Will consideration be given by early next year, after we have dealt with those aged under 60 who have underlying conditions, to putting in place a booster vaccine programme for the whole population? We have the infrastructure to do it and we have 90 million vaccines, some of which we will not be distributing under COVAX. We will have more than ample vaccines to do so.

At the outset, it is really important to say that all four of the vaccines that have been used in Ireland are very effective, perhaps not as effective against transmission as we hoped but extremely effective in reducing hospitalisation and the need for ICU care and against death. What is remarkable is that, in the past two weeks or so, we have had as many cases of Covid detected as we did in the first six months of the pandemic, yet we have not seen comparable numbers, thankfully, in our hospitals and ICUs, let alone deaths. It is because of the strength and efficacy of those vaccines that we are in a much better position relatively than we would be had we not had those vaccines, and a much better position than we were in last winter or last year.

The advice and decision from NIAC, as adopted by the Government, is that anybody receiving a booster shot will receive an mRNA vaccine, that is Pfizer, Moderna or the new one that will be approved quite soon. However, my understanding is that people cannot receive a booster shot until five to six months after their previous shot. I will double-check that for the Deputy. I believe we are going to need an extensive vaccination programme. We have now got approval for the over-60s, healthcare workers and people under 60 who are immunocompromised. I think we will need approval, and we will be seeking advice and approval from NIAC, on extending the vaccine booster programme more widely, particularly to those under 60 with chronic conditions. I know NIAC and NPHET are examining the evidence on that all the time.

The next speaker is Deputy Pringle, on behalf of the Independent Group.

I want to raise a very serious case of abuse and neglect by the HSE at Ard Gréine Court in Ballybofey, and the delay in publishing the Brandon report, which outlines what was not done to protect the residents there. The report highlights catastrophic failures of the most vulnerable people by our health services. There is a catalogue of abuse and neglect. The report identifies limited reports of abuse and inappropriate sexual behaviour from 1991 and concentrates on the period between 2003 and 2016. In 2011, management reported the issue to the Garda, as did the whistleblower. In the same year, after the report to the Garda and HIQA by the whistleblower, the individual identified as "Brandon" was isolated within the centre and the abuse stopped. In 2013, because of financial constraints - that needs to be restated; it was done because of financial constraints - Brandon was moved back into the general population within the centre. The abuse started again and only stopped when Brandon was moved to a nursing home in 2016.

The HSE, the Garda and HIQA all have questions to answer in regard to how they did not respond to the needs of residents. The HSE has constantly moved to delay the publishing of the report. First, it was to preserve the identity of people. Then we were treated to the news of a Garda investigation on the day the Minister of State, Deputy Rabbitte, met with families in Donegal to explain to them what was happening. Now we hear there are no charges in regard to the investigation but, apparently, the HSE is still delaying the report, saying it does not reflect what it did. If it wants to put on record what was done, why not publish its own report? Unfortunately, I would say it would be a very interesting but short read.

We see in today's The Irish Times that HIQA has admitted that it was aware of the sexual assaults, but it did not call that out in its reports in March and May of 2016 even though it saw it on the files in the centre. The Taoiseach has said previously that he wants to see the Brandon report published. The catastrophic failures by the HSE to deal with the issues, by HIQA to highlight them and by the Garda to deal with complaints have left families with half-truths and without the full story of what happened to their loved ones.

It is time to respect the existence of those without a voice, who the State was supposed to protect and defend. Will the Tánaiste call today for the Brandon report to be published and add the strength of the Dáil to the calls for publication of the report? Also, how can we be sure that there are no other Brandon-type reports gathering dust in HSE headquarters which we do not know about?

I thank Deputy Pringle for raising this issue and acknowledge his advocacy on this very sensitive matter. Anybody who has read or listened to reports on this issue will have been shocked and very upset at what happened and will struggle to understand how something like this could happen. When I heard about it, I was shocked and appalled that anything like this could happen anywhere at any point in time under any model of care, and for so long. My thoughts in the first instance are with the individuals and families affected. None of us can begin to imagine what they have been put through.

The HSE commissioned the national independent review panel to carry out a review of abuse allegations at a HSE-provided residential service for adults with a disability. The purpose was to review the governance arrangements in the facility and to understand why the situation had continued over a period of years without any effective action being taken by management during Brandon's residency to stop and prevent these assaults. The report identified 108 occurrences of sexually inappropriate behaviours by one resident, referred to by the pseudonym "Brandon", towards 18 other residents of the facility over an eight-year period between 2003 and 2011. The report notes that these incidents occurred with the knowledge of some staff and management of the facility at that time. It was eventually brought to light by the actions of an individual who approached a public representative in October 2016, who, in turn, brought it to the attention of the general manager of the county's disability services.

The safety and protection of vulnerable people in the care of the State are paramount, and the Government's first concern is to ensure that the needs of the current service users are being prioritised. The HSE has assured the Minister of State, Deputy Rabbitte, that there is no ongoing risk and that the national governance and accountability structures to oversee the implementation of the recommendations arising from the report are in place. The HSE board has also advised that its focus is on ensuring that all the recommendations of the report are promptly acted on by the HSE.

With regard to publication of the report, An Garda Síochána has asked the HSE to withhold publication for the time being while it considers the findings. The HSE has indicated that it will publish the findings once it has received clearance to do so. The Minister of State, Deputy Rabbitte, will engage with the HSE board on this in the days and weeks ahead. The Minister of State has also written to the Garda Commissioner about the publication of the report. The Government and I support her in this regard and believe that it should be published as soon as possible and without further delay.

I thank the Tánaiste for his response. I pay tribute to the Minister of State, Deputy Rabbitte, for the work she has done on this and on trying to get the HSE to own up and publish the report. That is vital because how can we be certain that the HSE is implementing changes that could prevent this happening somewhere else? Also, how can we be certain that it has not already happened somewhere else? At this stage, unfortunately, I have no faith in the HSE to deal with this issue. If I had not raised this with the previous Minister of State with responsibility for disabilities at the time, this would have been buried already within the HSE. The Minister of State, Deputy Rabbitte, has put pressure on the HSE, as a result of pressure I have put on her. She has taken it on and worked very hard to make sure this would happen. It must happen because we need to be confident that this will not happen again. That is the reality. The families have said this and are very strong on this matter. They need to know what happened. It is about making sure that it does not happen again. That is the important thing.

I urge the Tánaiste to push for this to be published, and to push the Garda to say it is not interested and that it is not going to go any further on this. It is very interesting that it is only taking an interest now. This must be published and we need people to take it into account and make it work.

We will certainly do that. The Government will press the HSE and the Garda to have this report published. It needs to be published for two reasons. The families concerned have a right to information and a right to know what happened, who knew what at what point, and how they acted. Anyone involved in this, including some of the staff members - some may have a case to answer and others may be entirely innocent - also have a right to know what is in this report. As the Deputy rightly points out, it is essential that we see the report so that we can be assured that something like this will not happen again. It is hard to contemplate how it went on for over eight years with more than 100 sexual assaults and happened with the knowledge of some of the management and staff. It is hard to comprehend how that could be the case for so long.

As the Deputy acknowledged, the Minister of State, Deputy Rabbitte, has been very active on this issue. Once she became aware of it, she has been very engaged. On Friday, 15 October she met the families who wished to meet her. She has indicated that the focus must now be on ensuring the findings and recommendations of the report are appropriately dealt with.

The recent budget slashed €88 million off the allocation for regional and rural roads. These local and regional roads are the arteries that connect many parts of the country and are highly trafficked routes. These roads represent 96,000 km of the total 101,000 km of our public road network in Ireland, carrying over 54% of the traffic, but have remained chronically underfunded since the financial crash. Poor quality roads can be a major cause of concern to communities, directly impacting economic development in our regions and rural areas. Ongoing underinvestment in these roads has now created a potential crisis, which the Government conveniently chooses to ignore.

Analysis done by the Department of Transport under the Strategic Framework for Investment in Land Transport, which was published in 2015 and updated in 2019, conservatively estimated that investment of at least €630 million per annum was needed to maintain the regional and local road networks in a steady-state condition. This means that without this minimal investment our road network will continue to deteriorate each year.

My constituency of Cork South-West has one of the worst road networks in the country, according to an independent report by the All Island Research Observatory, AIRO, which was carried out by Maynooth University and commissioned by Cork County Council. It stated that €750 million was needed to bring the roads in County Cork alone up to the standards set out by Engineers Ireland. It also stated that under current Government funding for County Cork roads alone, it will take 52 years to bring our roads up to the standards set in other counties. This report was carried out last year before the Government slashed the roads budget this year.

The National Oversight and Audit Commission 2020 report states that a staggering 33% of local primary roads require urgent structural defect rehabilitation, with 23% of the county's regional road networks being in a similar shocking condition. According to the AIRO report, County Cork has the highest level of structurally unsound roads in the State. This should have warranted a major investment in regional roads in the 2022 budget rather than the cuts announced. Despite this stark warning and many years of serious underfunding for roads since the financial crisis, only €561 million has been allocated for local and regional roads in 2022. This application represents a deep cut of €23 million from the 2021 allocation and is at least €70 million below what is needed just to maintain the existing network.

Additionally, the national roads budget has been reduced by €65 million for 2022. Taken together this means an enormous €88 million or 7% cut, meaning any new capital investment projects are off the table. When the Tánaiste, the Taoiseach and the Minister, Deputy Eamon Ryan, kicked ball around Páirc Uí Chaoimh recently before they announced funding for roads for decades to come, were they aware of this independent report carried out by AIRO on behalf of Cork County Council indicating serious under-resourcing of our roads in west Cork? If so, why was no plan announced for any of our urgent road projects in west Cork?

I am not sure those figures for the transport budget and the budget for roads in 2022 are correct. I will need to go back to office later and check on them. As far as I am aware, we have found additional funding for the remainder of this year for local and regional roads. That is coming from the Department of Transport budget, which will not be fully spent this year and will need to be carried over in part into next year. We also found additional funding for the local improvement scheme for laneways and rural roads in particular.

That is coming through from the Department led by the Minister, Deputy Heather Humphreys. We must maintain that funding in the years ahead, given the long list of projects that are still awaiting funding.

As the Deputy acknowledges, we have many roads in Ireland relative to our population and much of that is down to our settlement patterns, which are quite dispersed and not as concentrated as they might be in other countries. That makes them particularly difficult to maintain, but we should maintain them because motorists also pay much tax, whether it is motor tax, vehicle registration tax or the tax on diesel or petrol. Much of that should be used to maintain and improve our roads.

Local authorities can help as well and no local authority should consider itself entirely dependent on central government for funding for roads. They have the capacity to use money from the local property tax and commercial rates to improve their roads and it is appropriate that they should do so. Some money should come from central government but there should also be money coming from local resources. It is important that the two of these elements happen rather than just one.

On the question of roads programmes in the round, the national development plan, as referenced by the Deputy, provides for a 2:1 split on spending on new transport projects, with two thirds spent on public transport and one third spent on new roads. In the past year, we have seen some significant new road projects go to construction. For example, we have the next phase at Dunkettle, outside Cork city, which the Deputy knows well, and the Moycullen bypass just west of Galway city, which many people here also know well. There is also the Moyross road outside Limerick city and the Turlough to Scramogue road, which is an upgrade of the N5. Despite claims to the contrary, in the past year alone five major road projects have been signed off by the Department of Transport and its Minister. We expect to see further road projects being signed off in the year ahead.

I thank the Tánaiste for his reply. The budget slashed €88 million from regional and rural roads for the coming year. Every time the Tánaiste and his colleagues make announcements on roads, west Cork is always omitted. I remind the Tánaiste that we pay motor tax down there too. He should not think we are going around without taxing our vehicles in west Cork. The funds should come back there as they do everywhere else.

I asked the Tánaiste a question a while ago. Before he, the Taoiseach and the Minister, Deputy Eamon Ryan, sat down and approved the recent announcement of massive funding, had they read the AIRO report? This was an independent report initiated by Cork County Council. It is vital that the Tánaiste give a straight answer on this. If they had read the report, it would have made for stark reading.

When they announced their plans for Ireland at Páirc Uí Chaoimh recently, did they include the completion of the Bandon southern relief road, which has been awaited and promised for decades but not delivered? Did they announce plans for a full northern relief road for Bandon so the town can thrive as a business location? Did they give the green light for the Innishannon and Bantry bypasses or funding for long-awaited passing bays on the N71, the Bandon-Clonakilty-Skibbereen road, or the R586, the Ballineen-Dunmanway-Drimoleague road? I did not hear any announcement for these roads but if I am wrong, will the Taoiseach tell me or the country when one or all of these projects for west Cork will start?

I appreciate that these are important questions and these are important projects for people living in west Cork but that question is probably best put to the Minister for Transport rather than me, as he would have the up-to-date information. I will certainly let him know the Deputy raised this question today in the Dáil.

I am very aware of the strategic framework for land transport investment report as it was commissioned some time ago, when I was the Minister with responsibility for transport. I am familiar with it and have read it.