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Dáil Éireann debate -
Tuesday, 15 Feb 2022

Vol. 1018 No. 1

Ceisteanna ó Cheannairí - Leaders' Questions

Last week, people hoped the Government would finally respond to the unbearable cost of living with measures that would make a difference. This did not happen because the Government simply does not get it. Tá an pacáiste costais mhaireachtála a d’fhógair an Taoiseach an tseachtain seo caite i bhfad ró-bheag, i bhfad ró-dhéanach. Is ar éigean go bhféadfadh sé difríocht a dhéanamh.

At the weekend, I asked people to share their cost of living stories with me. In a matter of hours, I received almost 1,000 replies. These are stories of extortionate rent, of cold homes, of struggling to put food on the table and fuel in the car, and of unaffordable insurance and childcare. These are stories of hardship and worry, which are pushing families to the edge. I will share some of these stories with the Taoiseach. Kieran wrote to me stating:

We have respectable jobs. [but] Our apartment is an ice box- we have to choose between food and my daughter's medicine or heat. Our daughter...wear[s] 2 pairs of PJ's [pyjamas] during the day and 2 at night while covered in 2 [or] 3 blankets to keep warm. We can't afford childcare so my parents babysit. It's impossible to get on the housing market. I feel guilty every night.

Barbara said:

We have nothing left. I can't buy the same amount of food I used to buy. I buy the cheapest meat. I just hope that nothing breaks down like my car or...[my] washing machine.

Amy told me:

We work full time. We're struggling to put oil in our tank and diesel in [the] car. [We] pay insurance that is colossal, feed ourselves and keep things going. There’s only ... two of us [but] I can't imagine what it would cost if we had kids.

Janice told us:

€950 in rent for [a] one bedroom ... spending €40-50 a week [on] petrol. €2000 [on] insurance. Bills haven't arrived yet for 2022 but I'm really scared.

Robert told me:

I'm getting electricity bills at 240-260 euro and rent of €1,100 for a damp 1-bed apartment. Something needs to be done."

Eamonn said:

After paying utility bills, it is then a toss-up between food and rent. I had to request ... help from the ...Vincent De Paul to get some food. I'm feeling so lost.

Caoimhe says:

I’m a 26-year-old teacher. This year I have found it so tough...[just] to keep myself afloat. My cost of living is nearly one whole pay check. My question to ... government is when will it change? I’m working to survive not [to] live.

Finally, Anna said:

My ESB bill was near[ly] €400. The Government credit isn't worth the paper it's printed on. What about the cost of my petrol? My rent? This government has left me behind.

These stories are just a glimpse of what people face. The package announced last week offered only the bare minimum and it will not make a dent for people. It is very clear that the Government needs to do much more but yesterday, the Taoiseach said there would not be any further interventions until the next budget. He shows no urgency but instead dithers and delays. The Taoiseach cannot seriously suggest that those who are struggling to pay their bills today must wait until October when the Government might possibly intervene. The house is on fire now. Workers and families cannot wait seven months for a fire brigade that might never come.

I thank the Deputy for raising this issue, which is a very serious one for many people throughout the country.

We know that inflation has risen very significantly globally. The origins of this are fundamentally global both in terms of oil and gas prices which have risen dramatically across the world - the Deputy will have to acknowledge that - and the unevenness between the supply of products and the demand that rose dramatically as a result of societies and economies reopening and emerging from Covid-19. This is true all across Europe. Ireland has not escaped that global phenomenon of inflation.

In the budget we allocated over €1 billion between tax and social protection measures to help to cushion people in respect of increases in terms of the cost of living, including a €5 increase in the weekly welfare rates; a €5 per week increase in the fuel allowance; a €3 per week increase in the living alone allowance; a €630 million package of income tax and USC reductions and parents' benefits increasing from five to seven weeks from July. In addition to that, the measure we announced last week was for over €500 million, which will result in cutting electricity bills by €200. In regard to the fuel allowance, there is an additional lump sum payment of €125 and the threshold for the drug payment scheme is being reduced from €100 to €80. The Deputy mentioned that Kieran was worried about the cost of medicines and so on. That measure was deliberately targeted at families with significant medical bills. We have reduced that significantly over the past while. There is also a front-loading of the working family payment; a 20% reduction in public transport costs and fares, which will affect and help about 800,000 people who use public transport to get to work and so forth and a reduction in caps for school transport fees for the next academic year.

The Deputy is saying that is too little. Hence, I have to say what she seems to be proposing would be inflationary. The measures the Deputy is advocating would make things worse. On housing, in the budget we have allocated very substantial funds for house construction. We accept that we need to build far more homes and far more apartments than we currently are building. The good news is that throughout 2021 there were 30,000 commencements, the highest since 2008. I would again appeal to Deputies to allow projects to get off the ground. Supply is essential to deal with the housing crisis. Supply is essential to get rents stabilised and reduced. If we do not get up to 33,000 per annum built over the next year number of years, rents will not stabilise and will not come down. People who are objecting left, right and centre to housing developments are not going to help renters. They are not going to help people who are paying too high a rent at this time.

On childcare, the Government is committed to the sector. In the most recent budget, we put a significant allocation of funding towards childcare, to improve the pay and conditions for people working in the childcare sector and to create career pathways. Housing and childcare are two big cost items. We want to go further in the next budget in terms of access and affordability around childcare and we are going to do that. We must also acknowledge that this economy has rebounded very significantly because of good and sound economic management. I am not sure the Deputy acknowledges that. We are near to being back to full employment much earlier than anticipated. Ireland is one of the fastest growing economies across the European Union, with many people securing jobs much earlier after we emerged from the pandemic than would originally have been anticipated. That should be acknowledged as well.

The Government supports in terms of supporting wages, supporting businesses to keep people employed and the pandemic unemployment payment represent unprecedented intervention by Government in the economy over the past two years.

I shared stories with the Taoiseach, real lived experiences in the here and now. People are making choices between heat and food. People feel lost and frightened. It is not an exaggeration to say that families are staring into the abyss. That is the truth. You cannot spin the truth of people's lives. The Government has not cushioned these people or their families. The budget did not do it and the package announced last week did not do it. They are the facts. I hope the Taoiseach will show a willingness to listen to that reality.

What I am asking for and what these families need are initiatives that take costs down. I have shared with the Taoiseach the fact that many people are shelling out huge sums of money to live in small and damp accommodation - kips, quite frankly, if I can use that term. I have asked the Taoiseach time and again to intervene to bring the cost of rent and childcare down. We have also asked him to ditch the notion of a carbon tax hike in May. He refuses to do those things. He cannot spin the truth of people's lives. People cannot wait until October for relief and real help. I am asking the Taoiseach again to hear these stories, respond and act now, not to drive inflation but to take costs down.

We all know people are suffering the brunt of the current inflationary cycle. Everybody knows that.

The Taoiseach should do something about it.

Inflation has gone up dramatically all over the world. The difference between the Deputy's party and the Government is that we are doing something concrete and substantial about it.

The Government is making it worse.

We are not just sounding off about it. The Deputy has put forward very little of substance to deal with this current inflationary cycle.

The Taoiseach should give himself a rise.

As far as the Deputy is concerned, we should throw another €2 billion or €3 billion at the problem. That would be very inflationary. The Deputy disagrees with the basic premise that underpins the economic model in this country. That model has resulted in a significant recovery from the Covid-19 situation. It is challenging right now because of this inflationary cycle. We want to work with people, trade unions and employers to navigate our way through this pandemic-generated inflationary cycle and to do it in an intelligent way that protects people's basic cost of living and jobs. Above all, we want to allow investment to continue in this country to allow more houses to be built. The most effective thing people and Oireachtas Members can do is to stop objecting to housing developments.

The Labour Party believes in a fully funded, single-tier public health service. I was part of the team that spent 11 months writing Sláintecare. An extraordinary series of leaks was reported in the Business Post, revealing a dysfunctional relationship between the Department of Health and the HSE. That leads me to believe we are further away than we have ever been from the single-tier public health service we desire. To be frank, the commentary in the meeting that was the subject of the leak was quite derogatory from a relationship point of view as regards how we are ever going to achieve the service we want. The relationship between the HSE and the Department of Health is obviously going to be damaged. I believe I can vouch that this is the case.

Also worrying is how that will impact on the real lives of people. Officials in the Department of Health are saying that the idea we will recruit 10,000 people this year is, and I apologise in advance for the language used by one of the officials, "batshit". That is what those officials think about the recruitment of 10,000 people we need for our health service. There were many other similar comments. This was the type of meeting that was going on in the Department of Health relating to the necessary recruitment in our health service. What does that say about the Department of Health? What does it say about the Minister for Health and how the Department is being run? In fairness to the two junior Ministers who were on "Morning Ireland" the past two mornings, they tried to give some account of it but the Minister for Health is accountable. This comes after some terrible information emerging regarding the recruitment of a consultant psychiatrist in south Kerry. We know that 700 consultant posts are vacant. We know from Simon Carswell in The Irish Times about the shortage of GPs across the country. One in five GPs is expected to retire by the end of the decade. We need 2,000 more. In 13 GP areas, medical cardholders have been without a permanent doctor for over a year. There are 26 vacancies on General Medical Services, GMS, panels, covering 17,000 patients. It goes on and on. Many of us know of towns across Ireland that have no GP. We have an opportunity post Covid to put in place what we need and desire, that is, a single-tier public health service. The long-term health impacts of a lack of continuity of care and the difficulty of getting an appointment will cause even more waiting lists and issues.

Evidence from the UK shows that earlier intervention and having extra GPs per head of population saves people from acute and chronic illnesses.

We have a huge problem. We know that there are issues in respect of the relationship between the Department of Health and the HSE. I want to ask the Taoiseach quite clearly on the floor of the Dáil if he believes that we will recruit the necessary 10,000 staff for our health services this year. What plans does he have to ensure that we will resource the adequate number of GPs we desperately need across the country?

I thank the Deputy for raising this issue. The article to which he refers relates to a secretly recorded transcript of a meeting-----

That needs to be looked into.

-----which has its own issues attached to it.

I agree totally.

I believe that public servants and people more generally are entitled to brainstorm and hold meetings without being secretly recorded. That is a very basic right and entitlement of people. In terms of the relationship between the Department of Health and the HSE, the Minister holds biweekly meetings with the CEO of the HSE, the Secretary General of the Department of Health and the chairman of the HSE board. The Comptroller and Auditor General audits and signs off on the accounts of the HSE. That is how it operates.

More fundamentally, we need to stand back and observe that over the past two years there was record recruitment to the health service. The net figure was 12,500 people. More than 32,000 or 33,000 people gross were recruited. To just stand still, the HSE must recruit 9,500 people every year because of 9,500 people going in different directions and into different careers. That is an extraordinary level of recruitment. The net gain of 12,500 over two years is a record high number of recruitments. Add to that the 4,000 who were recruited as test-and-trace staff and for the vaccination team. A great deal of work went in there. There are 132,000 people now working in the HSE and our health service.

If we stand back from all that, in the past 30 years and 20 years in particular, we have witnessed very dramatic improvements in health outcomes, with major gains in longevity and lifespan. I say that because people need to realise that our investment in health services is delivering dividends, be it in the context of stroke, cardiovascular or cancer strategies. Survival rates in all those key areas have improved significantly over two to three decades. That must be acknowledged in all our commentary on the health service. The health service will always create, understandably and deservedly, issues of concern, given the enormity of it and the proportion of the population it covers.

That said, I am still impatient for reform and progress. An integrated financial management system is required and needed in the HSE. That is absolutely the case. When I became Taoiseach, I told the HSE, the Department of Health and the Minister that we need to modernise the information technology systems in the area of health in the context of the delivery of healthcare services. I refer in this regard to unique patient identifiers and so forth. Covid-19 intervened and, irrespective of what Deputy Kelly says, the HSE and health service rose to the challenge and developed a vaccination programme that is without question one of the best in Europe or the world. We need to acknowledge that.

I thank the Taoiseach.

There have been successes, but there are also, in my view, major concerns around the delivery of services-----

Time is up now, please.

-----in some aspects of mental health, without question, as we witnessed with the County Kerry child and adolescent mental health services and in other areas as well.

We have gone way over time.

Not unexpectedly, the Taoiseach did not answer the question. Will 10,000 people be recruited? Are the officials telling the truth in flowery language, for want of a better phrase? These are political targets. Is the Government going to meet them or not?

No, they are not political targets.

They are targets that are given out to people as answers. In fairness, we can only take the information that is given to us.

In the Taoiseach's constituency at Cork University Hospital today, dangerous levels of overcrowding exist. I have spoken about the situation in University Hospital Limerick on more occasions in the House than I have spoken about any other matter. That situation still obtains today.

There are 532 people on trolleys in our hospitals, over 720 vacant consultant posts and 4,500 funded positions that officials in the Department of Health are saying will not be met. These are record statistics going in the wrong direction. This needs to be arrested immediately. Otherwise, we are heading into a full crisis after coming out of such a difficult period in which the heath service has done so well.

Thank you, Deputy.

What is the Taoiseach going to do to ensure we get the consultant and health professional posts filled-----

The time is up, Deputy.

-----and the GPs into the system, as per the statistics he has given to many of us in this House and which he has committed to doing?

First, in terms of the transcript that was published, I was not there and do not understand the context, tone or whatever. Not all the material in it was accurate. Politicians did not set recruitment figures at all.

The Taoiseach gives the answers.

We did not set any recruitment figures.

So the Taoiseach is not giving the figures.

Will the Deputy let me answer the question? The transcript, or contributions within the transcript, suggested we did.

(Interruptions).

I will answer if the Deputy lets me answer.

The Taoiseach should be allowed to answer without interruption.

For example, the HSE came forward last year, not politicians, with a figure of 16,000. It was presented to a health committee meeting: the HSE said it would recruit 16,000 in 2021. This year, when it initially made its bid, it said it would recruit 10,000. Its HR team is now saying that, given the current labour market situation, it could be 5,500 net but it will try to trump that. Discussions are now under way between the Department of Health and the HSE in respect of utilising the funding that will not be used for the 10,000 recruitment figure on waiting list initiatives and other initiatives within the health service.

The material on mental health provision is completely wrong.

The HSE looked for approximately €35 million, including €24 million for new developments and €13 million for existing level of service, ELS, provision.

The time is up.

It got €37 million. An additional €10 million was added because everybody in this House was saying we need to do something in regard to the mental health impacts of Covid-19.

Is the Taoiseach saying he is not in charge?

We responded to that and allocated a further €10 million, which should be within the capacity of the health service and the HSE to spend and distribute.

Time is up, please.

How many posts will be filled?

I just gave the Deputy the figure the HSE is saying.

Thank you, Taoiseach. The time is up.

Can the Taoiseach honestly say to workers, pensioners and people on low and average incomes, with a straight face, that the paltry set of measures he announced last Thursday to deal with the catastrophic rise in the cost of living is adequate? Can he seriously suggest that is the case? Average heating and energy costs are due to go up by about €800 a year. The Government is giving people back €200 a year and a little bit extra on the fuel allowance. Who is supposed to pay the rest for workers whose wages are increasing at maybe 1%, for public sector workers, or for pensioners and social welfare recipients who got an extra fiver in the budget? Who is supposed to pay the rest?

What about rents? There is absolutely nothing on that in the measures. Rents are up 10% year-on-year according to daft.ie. Average rents in Dublin for a one-bedroom property are now €1,500, with the average for a two-bedroom property at €2,000. People would need between €17,000 and €24,000 in income just to pay the rent. There is nothing to deal with the unaffordable situation in rents. Then we have the wider cost of living, including food etc which is up by at least 5.7% and probably more. Where are workers supposed to make up the difference? Can the Taoiseach honestly say it is enough? It is an absolute insult.

Yesterday, in an interview, the Taoiseach ruled out another possibility. We proposed last week that there be rent controls, caps on energy prices and the bringing up of wages. He is not willing to do any of those things to control the spiralling cost of living. He said yesterday that we cannot get rid of the universal social charge, USC, because it would be too expensive to do so. Of course, that is not what Fine Gael and Fianna Fáil were saying before the election in 2016, when the now Minister, Deputy Michael McGrath, said, as part of pre-election promises, the USC would be gone for everybody earning less than €80,000 within five years.

Paudie Coffey, who was Minister of State at the time, said in a press release and a Fine Gael manifesto that his party would get rid of the USC altogether. All of that is gone now; too expensive, apparently. As a result, we cannot give workers a break by getting rid of the USC. My question to the Taoiseach is if he honestly believes this is adequate? How are people supposed to pay their unaffordable rents or come up with the hundreds of euros extra in heating and energy costs if the Government rules out all of these things? Why is it that it is always alright for the workers to pay? They can afford it, but the Taoiseach says that we cannot afford to give them a break on the USC, that we cannot afford rent controls or that we cannot afford the energy price hikes, even though landlords-----

Time is up, Deputy.

----energy companies and corporations are making an absolute fortune at the same time that workers are being hammered as a result of the cost of living.

We provided €650 million in the budget to reduce the USC and tax, a move which the Deputy opposed. I would also make the point that he is against property tax. He is against carbon tax. He is against the USC. He is meant to be left wing. How are we going to fund the services?

Tax the corporations.

How are we going to invest in education, health and housing? How are we going to do that? The Deputy is far more populist than he is left wing. He is in one of the few left-wing groups in Europe that opposes all of those taxes and that does not believe that we need to broaden our tax revenue base to support workers-----

-----and people on low incomes and to invest in housing, health, education and childcare. We cannot do it. Some €4.5 billion comes in through the USC. If we just simply abolish it, we will not have the resources to invest in childcare, to invest in education and health and so on.

Tax the billionaires.

I genuinely put that to Deputy Boyd Barrett. I just do not understand where he is going to generate the revenue base that would create those billions.

Look at our budget.

Wages will rise in the next number of years. The Central Bank is predicting that wage rises will outpace price increases over the next three years, despite the spike in inflation this year. From the public service perspective, the Minister for Public Expenditure and Reform, Deputy Michael McGrath, arrived at an agreement with the public service unions last year on the national pay agreement, which allowed for increases. We will maintain our engagement and contact with the unions on the issue of wages, wage increases, sectoral agreements, etc. All of these are part of that broader agreement, as is the restoration of hours under the financial emergency measures in the public interest, FEMPI, legislation, etc.

The measures we brought in last week were designed to help as many people as we possibly could. The cut to electricity costs of €200 is a significant enough help to people. It will not cover everything.

It certainly will not.

We acknowledge that. This is because the Government cannot cover everything. There have been two years where the Government has invested to an unprecedented extent into our economy. It was unprecedented that the Government would underpin what had to be done. It was right that we did it because of the pandemic. However, this cannot go on forever; we cannot continue to fund every enterprise in the country through the employment wage subsidy scheme, EWSS, or the Covid restrictions support scheme, CRSS, forever. That was never on anyone's agenda. The object was to get through the pandemic and keep companies viable, keep enterprises viable and keep jobs intact. We took this action in order that when we come out of the pandemic, businesses can get back up and running and jobs can be retained. Through the pandemic unemployment payment, PUP, we wanted to enable people to get through the pandemic. However, there certainly seems to be a view that the Government can be the bank of last resort for everything in the country. It just simply cannot be. We need balance here.

There is a significant State involvement in the economy. There is no question about that. We have a strong social protection system, which is funded by taxation. If you take away the revenue base, then you undermine the raison d'être of our social protection system, which is a strong one. It can be improved, and we can target it more. We will continue to do that in the next budget, as we did in the last budget, particularly for families and for those who are on low incomes.

It seems that the bank of the last resort is always the workers’ pocket. That is the truth. What the Taoiseach is really saying is that the workers can take it in the neck. The elephant in the room in the context of his argument is the incredible increase in the wealth and profits of the richest in our society----

----while workers are having their pockets looted as a result of increased energy prices and rents that are utterly stratospheric and totally unaffordable. The Taoiseach did not answer my question about how workers are supposed to pay for these things.

He also did not mention the fact that profits in the last decade have gone up by 172%. He did not mention that we now have nine billionaires in this country, according to an Oxfam report, who have €42 billion between them. That sum has increased dramatically during the pandemic. That is the elephant in the room that the Government never wants to talk about. Some people are doing very well from price inflation, including the profiteering energy companies and the landlords whose income from rents has gone through the roof. The Government never talks about them. It is okay for the workers to take it in the neck. It is okay for their pockets to be rifled to pay unaffordable bills, unaffordable rents and unaffordable food prices. They can manage it. It is always possible to loot their pockets but it is never possible to put a bit of extra tax on those who can well afford it.

The Deputy is wrong. We are not talking about looting anyone or any workers.

That is the reality.

A €630 million package of income tax and universal social charge reductions was brought in in the last budget and the Deputy opposed it. That is what we did in the last budget. We brought that in.

We are for getting rid of the USC.

The Taoiseach, without interruption.

The other point I would make is that the measures we took benefit workers. Cutting electricity bills by €200 benefits workers.

Who pays the other €600?

The €125 lump sum for fuel helps those on very low incomes. The threshold for the drugs payment scheme coming down to €80 benefits workers, particularly workers and families with high medical bills. Capping school transport charges helps workers. Those are measures we took. The 20% reduction in public transport fares helps workers, particularly those getting the bus or train to work. It helps them if we can reduce their everyday expenses. I accept that it will not deal with the entirety of it because this is a worldwide phenomenon that we have to deal with and get through. Equally, the economic model the Deputy wants to create, which is his legitimate aspiration, would destroy the economic model that, overall, has served-----

That is working so well.

Actually, it has worked far better than the model the Deputy is proposing. Investment would flee the country; there is no question about that.

It is not working very well at the moment.

Actually, there is almost full employment at the moment.

There is not.

There are nearly 2.5 million people working in this country.

That is not full employment.

Those are workers who are working because of a model that has involved foreign direct investment coming into the country over the last 50 years. That is something the Deputy opposes deep down.

As a tax haven.

The Deputy has no time for it. It employs thousands and thousands of people and he tells me he is on the side of workers.

He wants to destroy the economic model to get elected and he would use every mechanism to do that. That is the raison d'être of how he operates. That is fair enough in one sense but people need to know it.

Just get them to pay their taxes.

As I stand here, people have been waiting three and a half years in acute pain for an orthopaedic appointment and a whopping four and a half years for a respiratory appointment. That is a 54-month waiting list for respiratory appointments and we are about to face into a potential avalanche of respiratory cases as a result of long Covid. According to research by the Oireachtas Library & Research Service, which I commissioned, an estimated 114,500 people and rising in Ireland have long Covid. It is rapidly becoming a hidden iceberg of long-term chronic illness for our struggling health service. In December, analysis from the Royal College of Physicians of Ireland showed that the shortfall in cancer diagnoses equates to a delayed diagnosis for invasive cancers of between seven and ten every day in 2020 alone. That is someone's mother, father, wife, husband, sister, brother, daughter or son. Last year, while still dealing with Covid, the HSE had to grapple with the cyberattack. On top of that, GP attendances are also down significantly due to a mixture of reasons, including cost, private patients unable to access any GP and those lucky enough to have a GP finding it difficult to get appointments. All these delays are leading to cancer being diagnosed at a later stage of the disease, when treatment options are limited and, tragically, the prognosis is poor. We urgently need to do things differently if we are to address these appalling waiting lists once and for all. There is no doubt that recruitment of staff is key but we have already seen from the Department of Health disclosure on Sunday, which was subsequently backed up by the HSE's chief executive, that we will be at least 4,500 staff short in the health service recruitment drive this year.

I accept that we cannot magically make staff appear but we could sponsor students in training today on the basis that they commit to working within the health service for a period after graduating.

Second, we need to look at the way the health system works now and how we can speed it up. For example, we could maximise the use of the existing health infrastructure by extending the operational hours so that we get more scans done on the same machine, including on Saturdays and Sundays, as well as using the spare diagnostic capacity within our smaller hospitals.

First, I thank Deputy Naughten for raising this very important issue. I also thank the Deputy for the research that he has commissioned. It is an interesting analysis, maybe I would suggest a preliminary analysis, in respect of long Covid that certainly will be part and parcel of the health service for quite some time to come and will be a significant challenge for clinicians for some time to come. It needs to be monitored. Steps are being taken also, from a research perspective, to analyse and monitor this rigorously to make sure that we can look after people and also see the more medium to long-term impacts of Covid-19 on a certain cohort of people.

In respect of waiting lists more generally, they were too long before Covid-19. That is the first point. The base was high coming into Covid-19. They have got worse because of Covid-19 and the two lockdowns in particular - the first lockdown in 2020 and the second lockdown because of the Alpha variant in 2021. The short-term plan in the autumn worked well - it reduced waiting lists by approximately 6% - but, unfortunately, then we had the restrictions coming into the end of December and January where the health service and hospitals were told to focus almost exclusively on Covid and the Omicron issue.

The Minister will shortly be announcing and bringing to Government a waiting list initiative for 2022, but coupled with that a multi-annual waiting list initiative in terms of getting those waiting times and the numbers on the lists significantly down from outpatient to inpatient to day case, including, of course, diagnostics etc. That needs a comprehensive plan. The overall sum of money is approximately €350 million. That will be made available in 2022 to deal with the waiting lists, including, obviously, the public health system, the National Treatment Purchase Fund and the utilisation of private sector capacity in an all-out effort to get these lists significantly down. Emerging from Covid, this is a key target and challenge.

The Deputy is correct also to identify room for efficiencies, particularly the utilisation of equipment and facilities over the weekend period etc. Every available opportunity to do that will be taken in the context of this plan. The task force is jointly chaired by the Secretary General of the Department of Health with the chief executive officer of the HSE, and with the senior HSE team on that task force as well with other key officials to make sure that there is a relentless focus on getting the waiting times and the waiting lists down because it is important in terms of people's individual health and the overall health of the country.

I am not disputing that the Government is spending money - this year we will spend €40,000 every single minute on the health service - but just throwing money at our waiting lists does not work within the health service. We need to see structural reform. For example, take the rapid access haematuria clinic - the blood and urine clinic - at Roscommon University Hospital, where 10% of referred patients have been diagnosed with cancer. It treats 70% of patients in one visit and 100% of patients are seen within the 28-day target time for urgent cases, yet this service has not been rolled out anywhere else. There are many cases of good practice in the health service but these never get main-streamed because it clashes with someone else's agenda. This has to stop.

There is something fundamentally wrong when it is easier to spend money on treating patients in private hospitals than on supporting innovation in public hospitals, which could make a real difference in the long term to waiting lists.

We do need reform. In the progress report on Sláintecare that will be released later today, we can see all of the work in terms of more and more primary care centres opening, GP chronic disease management improving all the time and GP access to diagnostics. Some 135,000 radiology tests were delivered in the community in 2021. There is now national coverage of community intervention teams. Approximately 18.7 million hours of home supports were delivered in 2021. That is helping more than 5,521 people who are receiving the service. That is 2.7 million hours more than in 2020. Significant progress is being made in that area by the Minister of State, Deputy Butler. Much more needs to be done. We must roll out elective care facilities. Proposals have come in for Cork, Galway and Dublin and people from the mid-west are now making submissions in that regard. They are very important as well.

I am delighted Deputy Naughten raised Roscommon hospital. Perhaps others across the country would take note, so that when we say we are going to do different types of services in hospitals it does not mean a downgrading but rather an enhancement of services.

It would be nice to have the sterilisation facilities in the empty room there that the Minister went to see a couple of weeks ago.

The Minister met the team in Roscommon on the issue the Deputy referenced earlier. The point I am making is that I have heard nothing but positives about the manner in which the reconfiguration of Roscommon hospital has happened, as opposed to people just chasing the latest electoral stunt.

That is because of the helicopter service.

It has happened for more than 30 years.

That was because of Deputy Frankie Feighan.

The time is up.

Twelve months later Frankie gave-----

I am just saying it should inform debates as well across the country in other locations.

I thank the Taoiseach. The time is up.

A lot can happen.

That concludes Leaders' Questions for today.

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