Impím ar Theachtaí agus ar An Taoiseach na srianta ama a chomhlíonadh. I make the usual appeal to Members to keep to time limits.
Ceisteanna ó Cheannairí - Leaders' Questions
In February 2015, a 100-year-old woman was left lying on a trolley for 24 hours in Tallaght hospital. The case sparked outrage and anger. At the time the Taoiseach described the incident as “a truly scandalous situation”. We were told this should not have happened and the cry from the Government was one of never again. In November of that same year, a 91-year-old man spent 30 hours on a hospital trolley. The Taoiseach's response was that the then Taoiseach and the Minister for Health must take responsibility for the ongoing crisis.
Fast forward six years to today, on his watch as Taoiseach, figures show that in January alone, nearly 1,100 patients aged 75 years and over were lying on trolleys for 24 hours and more. The Taoiseach was right in 2015 when he said that one elderly patient lying on a trolley was scandalous. That 1,100 elderly patients were left waiting on a trolley in a single month is 1,100 scandals, one after the other. Numbers are very clinical. Numbers are not personal but every one of these 1,100 is a person, somebody’s grandfather, grandmother, mother, father, brother or sister; somebody's loved one.
This crisis has not fallen out of the sky. The Irish Nurses and Midwives Organisation, INMO, has been ringing the alarm bell at the Government for weeks and weeks. It says we face an extremely dangerous situation and that in some cases it is the worst the organisation has ever seen. Yet the Minister for Health sits on his hands and the HSE fails to act. On 25 January, University Hospital Limerick registered a record number of people on trolleys for a hospital for a 24-hour period. That same day, trolley figures across the State hit a two-year high. Yesterday, in the Taoiseach's own neck of the woods, Cork University Hospital registered its highest number of patients recorded on trolleys since the trolley count began.
The big question that arises this morning is what exactly is the Minister for Health doing. What exactly is the HSE doing? The Taoiseach tells us we have to pay big bucks to get big results. The Minister for Health, Deputy Stephen Donnelly, is paid €225,000, Paul Reid of the HSE is paid €412,000 and Robert Watt who is the Secretary General of the Department is paid €298,000. I believe that when you pay people that kind of money you expect big results. You expect that the job is done. Yet promise after promise has been made but we still have a crisis in GP provision, we do not have enough inpatient beds or enough community recovery beds and the scandal of trolleys continues. Despite paying these three men almost €1 million between them, the root causes of hospital overcrowding persist.
Tá géarchéim tagtha arís leis an bplódú inár n-ospidéil. Ní rogha é easpa gnímh leanúnach ón Rialtas. Caithfidh an tAire cruinniú éigeandála de thascfhórsa na Roinne a eagrú.
Do the Taoiseach and the Minister for Health accept responsibility for the crisis in our hospitals? How is it that in the midst of this extraordinary crisis the emergency department task force has not yet met? I am asking that the Taoiseach instruct the Minister to ensure that the task force meets as a matter of absolute urgency.
Deputies
Hear, hear.
I thank the Deputy for raising the issue. Without question there have been record attendances in our emergency departments over the last month. The situation is very challenging in many emergency departments across the country with those record attendances. What is more worrying is the preponderance or majority of those over 75 years are presenting to emergency departments with more acute illnesses than would have been the case in previous times. The clinicians on the ground say that this is a legacy arising from the Covid period because people did not present earlier during the pandemic for obvious reasons. There were lockdowns and most recently during Omicron elective procedures were de-escalated and diagnostics were not at the same levels. For example, cancer biopsies or attendances went down by 15% in 2020. In the next period, we will witness delayed diagnosis coming to the fore, more acute illness, and more acute cancer presentations because Covid meant that people did not get the earlier interventions that would have been the norm without the pandemic. That is the reality. That is notwithstanding the fact that we have dramatically invested and increased home package care hours, for example. Some 55,000 families now benefit from home care packages that are fully funded. However, there is a problem around hospital discharging as Deputies will be aware. Some 50% of nursing homes and community nursing units have had Covid outbreaks now. The regulations governing that mean they cannot accept new patients for about 28 days. We understand why that regulation was put in. I understand that the Health Protection Surveillance Centre is examining that. That has created a problem in egress from hospitals which, again, is a legacy of Covid. Indeed, it is not just a legacy but a present-day reality of Covid which is preventing people from leaving hospitals when their care is complete. Bed capacity has increased to record levels in the last 12 months. Investment in health has been at record levels. I think it has increased by €6 billion since the original allocation of 2018. There has been a range of innovations. The Deputy mentioned GPs. There has been huge investment in general practice service in the last two years, particularly around chronic disease management and GP access to diagnostics. That has made dramatic progress. Some 138,000 radiology scans were delivered in the community in 2021. That reduces pressure on the acute services.
However, we must respond to this current situation by pressing ahead with increased capacity on the acute side but also by examining the situation with nursing homes and community nursing units and further delivery of home care packages as well. Across the board, a whole range of measures have been introduced because it is not just about one task force for one or two months of the year. It must be a more holistic approach that is system-wide within the health service. It must be on the primary care side, community care side and acute side and there must be discharge provision and capacity as well. Government is working with the HSE to ensure we can do everything we possibly can to alleviate the pressures on emergency departments right now.
In those circumstances the Taoiseach and his Government are failing miserably in their task. I do not accept his excuse that this is a consequence of Covid. For example, he said he would eliminate waiting lists when he was Minister for Health 20 years ago. We now have 900,000 people waiting on lists. In 2015, the Tánaiste, the Taoiseach's partner in government and a former Minister for Health, said people would be waiting no longer than 18 months to see a consultant. Last month 155,000 people were waiting longer than 18 months. I could go on and on.
The truth is the failure lies with a lack of capacity; that is for sure. We lack beds but also resources, theatre capacity and diagnostics. The list is very long. Arguably, however, the bigger failure is a failure to reform. I was very alarmed to hear, as recently as this morning at the health committee, that it seems the Secretary General of the Department of Health has not signed up for Sláintecare and has not signed up for the type of reform we need.
I will put it to the Taoiseach again. Does he accept responsibility for this situation? How is it that the emergency department task force has not met? I see the Minister has joined us. Can we have an explanation for that, given the chronic situation?
Hear, hear.
Hear, hear.
Does Deputy McDonald just say anything? Did she read the Secretary General's speech to the Oireachtas committee this morning? Where in that speech did she pick up-----
From his email. He said it himself. I will send it to the Taoiseach.
-----that he was not committed to Sláintecare? The presentations today reflect that commitment to Sláintecare but Deputy McDonald simply thinks she can come in and say anything and it does not matter whether it is true or not. She just comes in and says it-----
Taoiseach, answer the question.
-----and throws it out there. If you throw enough mud, it will stick seems to be her approach to what are very serious issues. Yesterday's progress report on Sláintecare shows very dramatic progress in a whole range of areas in respect of that plan. I referenced one, namely, GP access to diagnostics. The whole chronic disease management has resulted in about 220,000 consultations as GPs work with consultants. There is much innovation and much implementation going on. There are increases in bed capacity, there is the reduction of the General Medical Services, GMS, threshold-----
And people on trolleys.
-----there is the reduction in regard to medical card prescriptions and there is improvement in access. There are challenges and legacies arising out of Covid that Deputy McDonald should accept because it is obvious. It is obvious to anybody watching the situation.
There was already a crisis before Covid.
Whenever there are scandals in the public service the inevitable review concludes it is down to a "system failure". It is a loaded term and suggests there is some kind of automated process that has gone awry in some way and there is no need to hold an individual or, indeed, an entity responsible. A succession of scandals in the health service have been in the news in recent weeks. Just yesterday, we learned of a further scandal in disability services in the north west. A resident was able to access child exploitation material online on multiple occasions going back to 2016. Basic safeguarding procedures seem to have been either ignored or abandoned. Vulnerable children were seriously harmed in south Kerry child and adolescent mental health services, CAMHS. Residents with intellectual disabilities in a care home in Donegal were sexually abused with impunity and a child, Grace, with special needs in the south east was abandoned to an abusive foster home. Our most vulnerable citizens, who relied on the State to protect them, were instead physically, sexually or psychologically abused, and some of that went on for decades. The abuse was not a secret. People in positions of power knew what was going on.
In Donegal, the staff and management in that care home were aware of the horrific sexual abuse being perpetrated by a resident called Brandon. Their response to the abuser was to move him to different wards where he had new victims who were non-verbal and unable to advocate for themselves. They were left to suffer for a decade. The Director of Public Prosecutions, DPP, has directed there will be no prosecutions in that case. We may never know the full extent of the abuse suffered by Grace. The State was supposed to protect her but instead it sent her to live with demons. They tortured her for about 20 years. In addition to Grace, the whistleblowers paid a hefty price. We recently learned the DPP will not prosecute any of the officials or State agencies that had a duty of care to Grace, despite the fact the Garda has recommended prosecutions for endangerment and negligence. In south Kerry, hundreds of children and their families suffered unimaginable trauma when they were prescribed inappropriate medications and it had devastating consequences both physically and psychologically. A rogue junior doctor who was not supervised or managed by anyone in senior management for years is probably going to take the fall. The system will remain intact.
All these scandals have a central feature, namely, that there is no accountability and a lack of consequences. What is the Taoiseach going to do to consign the term "system failure" to history and instead have real accountability built into the system, accountability that has real consequences, including the possibility of prosecution? Does the Taoiseach believe the lack of accountability undermines the vast majority of really good people who work in those services?
There has to be, and should be, accountability. I am not clear what the Deputy is proposing. These are very serious scandals in themselves, in terms of the Grace case and the case of Brandon and what transpired there. The Deputy referenced the south Kerry CAMHS. At this initial stage, I would put a question mark after the word "rogue". I think that is judgmental of the individual because I do not believe it is one issue pertaining to one individual. There are issues in terms of prescribing and so on but whether it was wilful or not is a separate matter. That is part of the issue. It is easy for us in the Oireachtas to make judgments but when it comes to the law, the legal system and people's rights and entitlements, it is a completely different arena, and people have rights and entitlements.
It has been an accepted premise here that the DPP is independent of the political system. It has been long argued but I do not see how we could change that. I do not know whether the Deputy is suggesting we should change the status of the DPP and that there should be a different approach. On balance and having witnessed things over the years, I would not agree with the idea that somehow the DPP should be answerable to the political system because I am not too sure justice would be done, if I am frank about it. We have to be careful about that. We can perhaps look at other mechanisms to get better insights or explanations as to why certain cases are not proceeding but that then could in itself jeopardise cases into the future because no case is ever closed and new evidence can emerge that can lead to cases being progressed. The DPP must make assessments, and the Garda must make assessments on these matters. I can understand why people are very unhappy, in that the Garda wished for a prosecution in this instance but the DPP took a view, probably looking at the entire case, and made determinations. The DPP's office is independent of Government, and rightly so.
More broadly speaking, as I have said before in the House, we have established numerous commissions of inquiry on a whole range of issues. Invariably, one is never entirely satisfied with the length of time they take and the fact they never lead to prosecutions, because of their very nature, and can, in some instances, jeopardise prosecutions, in the sense there can often be a difficulty between the case being prosecuted in the courts and any material related to that prosecution being aired in a commission of inquiry.
There are very real issues for us to reflect on and consider in respect of how best we pursue these issues between, on the one hand, trying to get the truth and the accountability question on the other.
The Taoiseach's very first line that he does not know what it is I am proposing concerns me. I am proposing that we build accountability into the system. There has been a myriad of different reports. When harm has been done, the first response tends to be about financial compensation, which is appropriate, but very often whistleblowers and people who have been harmed want more than that. They want to be sure that the same people who have failed in their positions of responsibility will be held personally responsible and will not be there to repeat those failures. We do not build those systems of accountability into our systems. It is very obvious because week after week we hear of different scandals. There is an origin for that. How can someone move an abuser from one ward to another and not think that is wrong? How can someone, for example, disregard things such as safeguarding and feel there is no accountability? Why is accountability not built into system? That is the point I am trying to get to.
I 100% agree with the Deputy. Of course, people should not be moved. What happened was very wrong and it should not happen. It is incomprehensible that it happened as recently as some years ago, which is my understanding in respect of the Brandon case. Accountability is built into systems, but people contest who is or is not accountable. People will argue and will say it is not them but somebody else. It is not that simple because people have rights and they will contest whether they are the ones to be blamed for a given situation.
There should be accountability in every system. I have said previously that we need to build up the existing structures. HIQA, a body I established when I was Minister for Health, has brought more accountability into health than any other body, some of which is pre-emptive accountability. In other words, it is getting in there, doing unannounced inspections and forcing change in the system. Many in the health service complained about HIQA in the early days, but it has driven standards higher than they would otherwise have been. The agencies responsible for standards and regulation are the ones we need to strengthen and empower.
My question is in a similar vein to that of Deputy Catherine Murphy. I was shocked, as everybody was, to read the news that came out yesterday regarding yet another failure of HSE management in the north-west region. Recent correspondence from HIQA expressed concerns regarding a residential disability centre for adults in Donegal, where a resident accessed child sexual exploitation material on three separate occasions in 2016, 2017 and 2021. The HIQA report states that the HSE has repeatedly "failed to demonstrate fitness" to safeguard residents with disabilities in its centres.
It is important to note that the only reason we know of this incident, and of HIQA correspondence, is due to a leak. This is completely unacceptable and shows the ultimate problem here. It was the same case with the Brandon report, which was another example of complete failure of HSE management. The only reason this report came to light was that the Minister of State at the Department of Health, Deputy Anne Rabbitte, and I continued to press the HSE regarding it. The fact that a Minister of State had to continuously press the HSE in the first place just to get a copy of the Brandon report is extremely concerning and I ask the Taoiseach to consider this. To date, the Brandon report has still not been published, despite the families’ wish to see the full report, and we are again relying on leaks for information. Something needs to change here. When discussing the Brandon report last year, I asked how we can be sure this will not happen again, how we can instil trust in HSE management and, in the case of failures occurring again, how we can ensure we are informed of them. Sadly, months later we are again facing a similar situation and, again, the only reason we know about it is through leaks. The Taoiseach needs to put people’s minds at ease. We have to know that this will not happen again and that if it does, at the very least, we have to know about it.
A pattern of failure seems to be emerging among HSE management. We need an investigation into HSE management in the community healthcare organisation, CHO, 1 area, but we also need an investigation into this community healthcare organisation’s relationship nationally. That is a key part of this issue. There are serious concerns about how residential centres are currently being managed in Donegal, in addition to Cavan, Leitrim, Sligo and Monaghan, but I also have concerns regarding HSE management nationally and how the CHOs relate to national management. We also need to address problems with HIQA. I have concerns regarding its processes and I am wary of placing all the scrutiny on the HSE without recognising HIQA's role.
One way or another we urgently need an investigation into HSE management in CHO 1 and nationally. We need to know how management is being held accountable and how we can know that this will not happen again. Will the Taoiseach ensure that necessary and timely investigations into HSE management take place, following the ongoing patterns of failure occurring in our residential centres?
I thank the Deputy for raising these issues, which are very serious and are taken very seriously by the Government. As the Deputy said, the Minister of State, Deputy Rabbitte, has worked with him in respect of the Brandon report, which is a shocking and very disturbing report. What happened in that instance has caused enormous distress and hurt to the families involved. A national independent review has been commissioned by the HSE to carry out a review of abuse allegations at a HSE-provided residential service for adults with a disability.
In respect of the advice, the Minister of State sought the Attorney General's advice regarding the publication of the full Brandon report. As the Deputy knows, the HSE published the executive summary of that report last December. The advice received was that it is a matter for the HSE and the Minister of State may not direct the HSE to publish the report. The Garda is still completing its work and has advised the HSE against publication. The HSE, as the body responsible for publication, has determined that the report should not be published in full, but we are not finished with that yet. We will continue to pursue that because full transparency is required but, at the same time, we do not want to imperil or undermine any potential investigation the Garda may pursue regarding this.
In respect of the CHO 1 situation, HIQA advised the Minister for Health, Deputy Stephen Donnelly, and the Minister of State in December that the chief inspector had concerns about the ongoing governance of social care in CHO 1, including, as the Deputy outlined, a serious adult and child safeguarding concern. HIQA conducted unannounced inspections of all HIQA-designated centres for people with disabilities in Donegal, except those that had been inspected since September 2021. Preliminary feedback on the inspections has been provided to the HSE. HIQA's report on the inspections is expected shortly. I am advised, however, no issues were identified that have not been responded to appropriately, but we have to see the full report of those inspections. There are concerns, which the Minister is pursuing further, about the broader area of establishing the response and capacity of the CHO 1 area in respect of senior management there and how it is handling cases, some of which date back to the management of cases in 2016 and 2017. Terms of reference have been drawn up regarding that particular exercise.
More generally, the Deputy raised the issue of the HSE's nationwide response to matters of this kind. In the first instance, the HSE has a national framework in which there has to be full disclosure on issues such as this. There are clear benchmarks against which it needs to be judged in fulfilling those objectives.
On the CHO 1 issue, the Morris tribunal report covered the actions of the Garda. At the time, official Ireland wanted to make sure this issue stayed in Donegal. That was where it was seen to be, but we know that was not the case. We will end up in the same situation regarding this. That is why CHO 1's relationship, nationally, with HSE management also needs to be investigated.
On the Brandon report specifically, the Minister of State said she cannot publish it, which is fair enough, but the HSE can. That is a problem. The HSE is a law unto itself here. It works for us. We do not work for it. The HSE works for the Irish people. It is supposed to represent the Irish people not the other way around. It seems it is the other way around when we are dealing with the HSE. The Garda Síochána has completed its investigation in regard to the Brandon report so it cannot be held up as an excuse by the HSE.
We need an investigation. The most recent revelations took place after the Brandon report was published, such that management had not changed. We need to make sure that investigation takes place. We need to make sure that people have a fair hearing at all stages.
Again, I thank the Deputy for raising the issue. I hear what he is saying in respect of the publication of the Brandon report in full. As I said, the matter is not closed from the Government's perspective. We do not want to undermine any disciplinary issues or any other issues that may arise out of this.
There is nothing happening.
I am just making the point that it is not closed. We are not finished with this yet because it is a very serious case and a very serious issue. Speaking more generally, there has to be balance here. To return to the previous question, our existing agencies have to be able to do the work. Increasingly, almost daily now, it is an independent review for this and an independent review for that, where we have existing statutory agencies which are meant to be doing that work.
That has to tell you there is something wrong.
Hear me out. We have the Garda Síochána Ombudsman Commission, GSOC, in respect of the Garda-----
There is something wrong.
No. Into the future, we are going to have make sure that agencies such as HIQA and GSOC do their work like all of the other bodies that are there to regulate and to enforce regulation, otherwise we will have commissions being established every two months, with all of the implications that that brings with it. The Deputy will be aware that there are commissions of inquiry still going on six years later. There are issues that we need to look at collectively as an Oireachtas.
The Government blames oil prices for the energy crisis. The facts do not support the Government's argument that the hike in the price of the barrel of oil is the main cause of skyrocketing petrol, diesel and home-heating costs. This argument is wrong and misleading and I will explain why. In 2008, the cost of a barrel of oil was $162, the cost of a litre of petrol was €1.30 and a litre of diesel was €1.42. Today, the cost of a barrel of oil is $93, which is 74% lower than in 2008, but the cost of a litre of petrol is €1.74 and the cost of a litre of diesel is €1.64. If the price of a barrel of oil is 74% lower, why are Irish consumers paying 34% per litre more? As I said, in 2008 the price of a barrel of oil was $162. Today, the cost of a barrel of oil is $93 yet the Government is saying the cost of the barrel of oil is the cause of high fuel prices.
The carbon tax was first introduced in 2009 by Fianna Fáil and the Green Party. Carbon tax is the real reason for the increase in fuel prices and the pressure on people in terms of heating their homes. The hauliers and the farmers came here to protest but the Government has done nothing to support them. The price of oil is cheaper now than in 2008. The Government's percentage model on taxes is costing every household more. The Government needs to give the real facts and tell the public the problem is being caused by the carbon tax first introduced by Fianna Fáil and the Green Party in 2009. That is a fact. I am not making this up. People can Google it and they will see it for themselves. These are facts. The price of the barrel of oil is $69 cheaper today than it was in 2008. The Government is telling the people who are going hungry and who are cold in their homes that the problem is the price of the barrel of oil. It needs to stop giving misleading evidence to this House.
I would have to disagree with the Deputy. Let us deal with 2022, not 2008, which is a long time ago and there was a different economic situation.
It is about the cost of a barrel of oil.
I did not interrupt the Deputy.
The Taoiseach does not like to hear it.
The bottom line is this. We all know the current cause of the inflationary cycle is global. Oil and gas prices have risen dramatically. Two and a half months ago, on 1 December, the cost of the barrel of oil was $68. Do you agree?
It now costs $93 or $94. That clearly is a dramatic increase in a number of months, which the Central Bank and Europe are saying is a pandemic-related cycle of inflation.
It is a con job.
Natural gas costs £1.65 per therm on international markets, compared with 42 pence per therm last February. Higher gas prices have pushed up electricity costs as gas was used to generate half of this country's electricity last year. The latest CSO data on wages shows that average weekly earnings rose 5.4% in quarter 3 of 2021 from a year earlier and were up to 8.9% from their pre-pandemic levels in quarter 3 of 2019, which is contrary to much of what has been said here in the past number of weeks. That said, added to the energy issues, quantitative easing to respond to the pandemic globally is a factor. As we emerge from Covid, the fact that supply has not met demand in terms of products manufacturing and the supply chain and blockages, which were real but are easing somewhat now and we hope will ease further throughout 2022, are the causes of the current cycle of inflation.
(Interruptions).
To suggest that it is just carbon tax is simply not the truth. The story with the carbon tax is that we are giving the money back to the public in the form of the retrofitting scheme, where we will enable people to retrofit their homes which will lead to cheaper fuel costs into the future. We are giving money from the carbon tax to farmers for environmentally friendly farming programmes.
(Interruptions).
Additional income streams for farmers will arise from the distribution of carbon tax revenues. To protect against fuel poverty for those on low incomes and those depending on the fuel allowance, it enables us to make more generous provision in those areas, as we have done in the last budget and in the most recent package in terms of those in receipt of the fuel allowance.
The Government is robbing Peter to pay Paul.
The reality is that over the next decade or so, we will be moving more towards renewables. We will always need gas for the foreseeable future as a transitional fuel, but we will have to increase our renewable capacities into the future. Of that, there is no doubt. The current Ukrainian-Russian crisis illustrates that for Europe, not just for Ireland, more than anything else. It has caused a lot of instability in more recent times.
I will give the Taoiseach some facts. He said not to worry about 2008. In 2008, we were paying €6.44 per gallon of diesel. In 2022, we are paying €7.46 per gallon. In 2008, the cost of a gallon of petrol was €5.90. In 2022, we are paying €7.89. The current price of a barrel of oil is $93. It was $162 back then.
The Taoiseach spoke about retrofitting. Does he realise what retrofitting is? Since the announcement of the retrofitting scheme, the price of insulation has gone up by 17%. The Government has put in place a grant process, which is grand, but the cost of labour has gone up and the cost of materials has gone up. Retrofitting in terms of insulation and steel is oil based. All the Government has done in terms of the introduction of the retrofitting scheme is drive inflation through the roof because there is a lack of supply. I know that because I am a contractor. I see it every day.
The Government is so out of touch that it has increased inflation with the retrofit scheme. The grants should be increased with inflation. Let us take the example of a retrofit that costs €50,000 with €23,500 put in by the Government. If the cost of that retrofit goes to €70,000, the Government should bring its investment up to €35,000. That is how to deal with the issue. The Government has destroyed this country with inflation and tax.
First of all, the retrofitting scheme has not started yet.
We know that.
The Government has no money.
We have the money and it has been allocated. The retrofitting scheme clearly has not affected the current pandemic cycle of inflation.
It has.
I ask the Deputy to calm down. There is no need to be roaring about the issue. The bottom line is that in 2021, the country spent €6.2 billion on imported fuels compared with €3.4 billion in 2020. We spent €6.2 billion on imported fuels in 2021 compared with €3.4 billion in 2020. That is a €2.8 billion increase in the bill for imported fuel, largely reflecting higher prices on international markets. We spent an additional €1.5 billion on imported oil and an extra €1 billion on imported gas last year.
More tax is being charged.
The Deputy cannot deny the global nature of this.
More tax is being charged.
During budget time, the Deputy is the first in the queue looking for higher investment in roads, rail and projects in his constituency, and greater social protection measures. There has to be a revenue base to pay for all of that.
Do we get those things?
More tax is being charged.
That is the reality. The revenue we generate relates to what we can do for society and for the public, more generally.
We have to live, too. We have to live.
We have to be transparent and straight up about this. There is no denying the global nature of this issue. We must take measures to try to help people alleviate the pressure.