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Dáil Éireann debate -
Thursday, 5 May 2022

Vol. 1021 No. 5

Ceisteanna ar Pholasaí nó ar Reachtaíocht - Questions on Policy or Legislation

We will continue with Questions on Policy or Legislation. There is one minute only for each Member. I call Deputy Doherty.

Figures released by the HSE reveal that since the beginning of 2021, more than 3,400 nurses have been assaulted. That means seven nurses are being assaulted in our hospitals each week. If we consider all staff, then that figure goes up to 5,600 incidents of physical, verbal and sexual assault. These figures were provided to my colleague, Deputy Cullinane, in response to a parliamentary question.

In talking about her experience, one nurse described the accident and emergency department as "a pressure cooker", with "aggression [...] causing junior nurses to quit", while she no longer feels safe in her workplace. It is completely unacceptable that people are in this position. Our nurses and hospital staff need to be protected. We must acknowledge that overcrowding in our hospitals is, in the words of the president of the Irish Nurses and Midwives Organisation, INMO, Karen McGowan, "a recipe for disaster", which has increased anxiety and the risk of aggression. What measures are we going to take to ensure the safety of our nurses and hospital staff? Does the Minister agree that we need to urgently bring forward an accident and emergency department plan to tackle waiting times and overcrowding?

I accept what the Deputy said. What he described is intolerable and the details provided in response to the question from Deputy Cullinane raise serious concerns. I cannot let this pass without noting that if overcrowding is the real issue, then I can think of one hospital that is affected more than any other, and that is Holles Street hospital. It is the most overcrowded hospital and that is why we must act and make decisions in this regard.

The solution to this issue also involves the delivery of Sláintecare. That will be a way of taking care out to the community and of using many new remote sensing systems. Shift Left, Stay Left is a new policy being examined by the HSE. Much care can be provided using remote sensory devices, and that is better for patients, hospitals and the HSE's budget. These sorts of initiatives to remove overcrowding are going to be the key solutions.

I outlined yesterday the ongoing concerns the Labour Party has regarding the ownership, governance and control of the proposed new national maternity hospital. We welcomed the publication of certain relevant documents on the HSE website and the Government delaying the decision in this regard. Having listened to the exchanges this morning, however, it seems the Government is not proposing to make any changes. Yet we are still lacking some crucial information. We have still not seen the details of any correspondence there may have been between the Vatican and the Religious Sisters of Charity concerning the transfer of ownership. We understand that permission from the Vatican was required to transfer ownership, but we do not know if the Minister has seen that correspondence or if the Government has sought it. The Government may say it is relevant, but it is deeply relevant because it may answer the question of why the hospital site cannot simply be gifted to the State. If this new hospital is to be public in all but name and if a 299-year lease amounts to a public site in all but name, then why not put this matter beyond doubt and make it public? Let us see why the Religious Sisters of Charity cannot simply gift this site to the State.

The parties to that correspondence are probably following our debate here. It is up to them to decide whether they make public what is private correspondence. We must be careful regarding basic fundamental rights. There are rules around freedom of information and provisions governing which information by statute can be directed to be made publicly available. Private correspondence, however, is not included in that. Should the parties concerned wish to do so, I would welcome them releasing the correspondence. It would be a dangerous and difficult precedent, though, if we went down the road of governments forcing private correspondence to be made public. That has legal consequences, and it would be very risky.

Today is International Day of the Midwife. It is important to acknowledge the incredible work of our midwives. Unfortunately, the role of midwives in Ireland is greatly under-resourced. In many jurisdictions, midwife-led home births are the norm, but in Ireland, in some situations, women are forced into hospitals. In CHO 1, for example, covering Cavan, Monaghan, Donegal, Sligo and Leitrim, the HSE facilitated four home births between 2015 and April 2022. I repeat that it was four. Additionally, the HSE banned water births in 2020. The Community Midwives Association, CMA, and the Midwives Association of Ireland, MAI, have called this ban non-evidence-based, unethical and inequitable. Those organisations are calling for the immediate reintroduction of water birthing. What is the Government doing to support midwives and midwife-led home births for those who want them? Will the Minister for Health instruct the HSE to lift this ban on water births, with immediate effect?

I agree with the point the Deputy is making. Our maternity system is not sufficiently midwife-led. I think it should be. That is why I want to bring back to this debate something I raised earlier concerning how we implement the national midwifery strategy. It points in the direction not of a consultant-led, active management type of system, but, as the Deputy said, to a much more patient-centred and midwife-led system. This encompasses a range of different issues, including the arrangements referred to by the Deputy regarding pool-based systems. Therefore, I agree this is the direction in which we need to go. It is set out and agreed, but it is not being delivered with sufficient speed. We must have a debate and discussion about the nature of our hospitals' structures, etc., but the subject of having a midwife-led system, and its nature, is where this debate and our attention and focus needs go.

I raise the shortage of hormone replacement therapy, HRT, products in the State. Several factors are at work here, including demand, supply and price. Some women are finding it difficult to source some HRT products in the State. The British Government has prioritised this issue in respect of the demand, supply and price. What is the State doing about the situation many women here find themselves in?

This is a real issue. I am told there has been a significant increase in demand for HRT products, which has outstripped supply, as the Deputy said. A successful awareness campaign has seen demand for some products increase 4.5 to 7.5 times compared to 2019 levels. Suppliers have confirmed they have increased the planned supply of HRT patches to Ireland this year, while continuing to work to find solutions to the immediate supply issues. This is a global issue. Unfortunately, shortages of medicines have become increasingly prevalent globally in the last decade and they are a feature of modern health systems around the world. There are many reasons, I am told, for these shortages, including the shortage of raw materials, manufacturing difficulties, logistical transport issues and product recalls. Therefore, this is an issue and a global problem, but the Government and the health system are aware of it and trying to find solutions.

Aontú research has revealed that hospital mistakes have risen to 107,000 a year. Each instance represents damage done to a patient or a person suffering from ill health. There has also been a significant rise in extreme incidents, such as death or permanent incapacity, to 579 annually. This is happening because of a lack of accountability and resources. At the same time, the accident and emergency department in Navan hospital is threatened with closure by the HSE. I spoke to medical professionals in the Royal College of Surgeons of Ireland, RCSI, Hospitals Group, and they told me that the closure of the accident and emergency department in Navan hospital would be a travesty for patients in our region. Patients in County Meath would be forced from our hospital into a hospital group which has seen the highest level of adverse incidents in the country. If the Government proceeds to close the accident and emergency department in Navan hospital, it will have a fight on its hands, the likes of which it has never seen before. Tens of thousands of people will be on the streets and a Fianna Fáil or Fine Gael Deputy in County Meath will be a thing of the past.

Please Deputy, the time is up.

Will the Minister listen to the medical professionals and stop this travesty?

The Deputy is out of time. I call the Minister.

Regarding the specific issues, I do not have details about the specific hospital, but I will pass this information to the Minister for Health, Deputy Stephen Donnelly. I will also pass on Deputy Tóibín’s request for reassurance regarding Navan hospital. To make a general point, though, for all the failings of our system, recent analysis - and I do not have the exact figures, statistics or research here - has shown that our life expectancy in this country has increased dramatically. Independent international assessment of the outcomes experienced in our health system, which is ultimately measured in that length of life and the quality of the service, shows there have been significant improvements and that a good job is being done by our health system, despite all its failings, and the people working in it.

Nationally, 20,437 people are waiting for ophthalmology appointments, with 9,500 patients having been waiting for one year. Some people have been waiting up to four years.

It is clear that there is no proper co-ordinated regional approach to funding or staffing. The Mater hospital under the guidance of Professor David Keegan in collaboration with CHO 9 started a waiting list initiative prior to Covid. Through this initiative they have managed to drastically reduce the waiting list in the last two years, even through Covid. It is the only adult unit in this country to have achieved a reduction in figures this month in that there are only 94 people waiting. That is in sharp contrast to 4,885 people waiting in CHO 1. In CHO 5, which covers County Tipperary, there are 2,361 patients waiting. This is shocking and we need co-ordination. I salute Deputy Michael Collins who has his 90th bus going up to Belfast, the "Belfast or blind" bus, but we should not be having to do this. Surely we can deal with this and have it properly co-ordinated.

I thank the Deputy for his question and for raising the issue of ophthalmology. He is quite right that the numbers are very high. The figure of 2,361 in University Hospital Waterford in CHO 5 is correct. Currently there is a new theatre being fitted out in respect of ophthalmology. The Minister, Deputy Stephen Donnelly, has also made available €350 million this year coupled with the €50 million already in place for the National Treatment Purchase Fund, NTPF, for waiting list initiatives. The details are being worked out at the moment. What the Minister is hoping to achieve is that anybody waiting six months by the end of this year will receive the treatment they need.

I welcome the student council of St. Catherine's Vocational School in Killybegs to the Visitors Gallery. Recently, we have seen fish being landed in Derry for processing in Killybegs. The Sea-Fisheries Protection Authority, SFPA, has now removed the permission to land there, presumably because it is not a recognised EU port. The Northern Ireland protocol supposedly treats the Six Counties as inside the EU. Does this not apply to fish landings? What is the situation? The fish should be landed in Derry, transported to Killybegs and processed there as of right. What is the situation in respect of the protocol?

Deputy Pearse Doherty asked a similar question last week and I was able to give some of the details on the specifics of what has been happening in Killybegs. I do not have those details in front of me now. My understanding from the Minister for Foreign Affairs is that it is a port designation issue. I might ask him to comment briefly.

I can come back to the Deputy with more detail. This matter has been raised with me from a number of sources. My understanding is that this is a designation issue in respect of landing, as the Minister, Deputy Eamon Ryan, said. I am happy to talk to the line Minister and the SFPA and come back with more detail. I know it is causing concern in the north west.

Tomorrow in Cork and I think here in the capital there will be a march on behalf of parents of children with special educational needs and in terms of disability services and the lack of provision there. As a Government Deputy, I will be in attendance in Cork. Recently, the Minister of State, Deputy Rabbitte, and I attended a meeting with the 12 principals of the special schools in Cork. Thankfully, the HSE and the Minister of State committed to reinstating all the therapist posts lost when the PDS programme came in. That was very welcome and I understand it is happening right across the country in special education settings. That said, although the advertisement of those posts is welcome, we all know that filling them is the real challenge. Can the Minister brief me on how we are going to fill them? Will it entail outsourcing, training existing staff or how are we going to fill the posts?

There is a real need across the country for increased therapy for children and young adults with special needs. It is a real shortage. The shortage is also exacerbated by the difficulty in hiring new people. My understanding is that our assessment processes are so long that many of the therapists who should be engaged in therapy provision are actually in the assessment process. We need to look at that as part of the overall approach and measures. The issue was raised, debated and discussed at a Cabinet sub-committee in recent weeks and there is a real commitment to addressing the shortfall. It is not easy. I think there may be a need for training and education of new people. There is not a pool out there. I think that is the way to go.

In the latest draft of the Limerick Shannon metropolitan area transport strategy, phase 2 of the northern distributor road is not included. The National Transport Authority was before the transport committee recently and stated that it would be in the revised draft. It has now informed us that it is not in the revised draft because of a direct intervention from the Minister, Deputy Eamon Ryan, who wrote to the NTA and directed it not to include it. Is that correct? The northern distributor road, phase 2, is very important. Phase 1 is from Coonagh to Knockalisheen. We had that debate and thankfully it is proceeding. Why did the Minister make that intervention? Phase 2 of the northern distributor road is very important. Even the national development plan states that local authorities can bring forward important road infrastructure projects to deal with particular safety and access issues. That is what phase 2 of the northern distributor road is doing.

The NTA is correct in what it said at the committee yesterday. Going back to what I said earlier about visits around the country, I visited Clare County Council and Limerick County Council and was very open and public in giving the reasons I believe the strategic development of Limerick is in the centre, in the existing county and the centre of the city. There is real risk to Limerick if it spreads, alternatively, into Clare, on a roads based development model. As I said earlier on in respect of the national planning framework, we want to develop compact development on sustainable transport modes.

Did the Minister write to the NTA?

"Yes" is the answer. I also believe it is important for the likes of Ennis and Clare to develop, not as an adjunct sprawl out from Limerick but to see strong towns in Clare and a strong city in Limerick developing. That is why I believe the northern distributor road is not the right way to go. Public transport in Limerick is the way to go.

I want to raise the issue of Shabra Plastics in Castleblayney, County Monaghan, which is Ireland's only PET recycling company. It recycles more than 12,000 tonnes of plastic which it buys from materials recovery facilities. It sells 90% of the processed, recycled materials to Irish companies. This model has become untenable because some European countries, including the UK, have a levy on virgin material, increasing demand for recycled material. The Irish Government through Repak is paying a subsidy on recycling PET bottles but they are not recycled, they are separated and sold to the highest bidder. Currently they are being sold outside of the country. The Minister needs to take action to keep recycled material in Ireland to be reprocessed. There should be zero subsidy for exporting raw material out of the country. We are increasing our carbon footprint and putting 50 jobs at risk in Monaghan.

The Deputy raises a serious issue. The Government this week brought the Circular Economy, Waste Management (Amendment) and Minerals Development (Amendment) Bill 2022 to the Oireachtas environment committee on Committee Stage. That provides a lot of the answers and reassurances to the company. In the development of the likes of the deposit refund scheme, where plastic and PET bottles are not just thrown into the green bin and the average waste stream, that we get a very high quality stream of PET bottles that can be used in recycling I would imagine in the facility the Deputy is talking about and other facilities around the country. It is one of 200 measures in the waste action plan which we are going to deliver to make the circular economy real, reduce emissions, create jobs, and reduce waste and litter. It is agreed with industry. It is being delivered and is very real.

I have received correspondence from an importer advising that certain goods are coming into the Port of Cork that cannot get clearance there and have to be transported to Dublin in order to get clearance. There is obviously a fuel cost and an environmental issue. My understanding is that the Port of Cork has made a submission to the Department looking for the facilities to be developed. What progress has been made? Is it likely that we can have all goods coming in to the Port of Cork able to get the clearance there to be used on the Irish market? I think the goods involved are from outside the European Union.

I will follow up in my own Department and look for the correspondence from the Port of Cork. We do not want goods shipped from Cork to Dublin. I will follow up and reply directly to the Deputy.

When people are dealing with the State, lodging appeals, tax clearance or whatever, the State lays down very strict deadlines. If people do not comply with these deadlines their applications are rejected or, in the case of a late tax return, a financial penalty is applied.

However, when the State is dealing with the citizens, it often totally ignores their fundamental right to get things in time. In this regard, I could mention citizenship applications, passport applications, forestry licence applications and so on, but today I want to concentrate on a slightly different issue, namely, the inordinate delay with planning applications. There is a statutory objective of 18 weeks laid down for a decision. Applications for leave to-----

Very briefly-----

Still, the time is up.

Forty-two percent of appeals are not dealt with within the 18 weeks, and 532 applications have been on hand for over 18 weeks. When will the Government-----

We are way over time. It might be a topical issue subject.

-----deal with this scandal and introduce legislation to force An Bord Pleanála to give a service to the ordinary, plain people of this country?

The Deputy is absolutely right: there is a real problem. There are two key immediate solutions that the Government has to provide. I understand the Minister for Housing, Local Government and Heritage has, with the agreement of the Department of Public Expenditure and Reform, committed to additional staff for An Bord Pleanála. We need planning, ecological and science-based expertise, in addition to expertise in a range of other areas. The board needs additional resources; that is absolutely clear to me.

The Attorney General is conducting a review of the Planning and Development Act 2000 that will codify and modernise it. The Act has been amended so many times and is so complex, layered and difficult to interpret that it, too, is not helping in making fast planning decisions. The work is to be concluded by the end of this year. It is one of the most important projects or tasks taken on by the Government. I have 100% confidence in the ability of the Attorney General and the special team he has brought together to deliver that. That will be key.

I want to raise the matter of children with disabilities in County Meath who have been transferred to the south Louth team under the progressing disability services programme. Children who have been transferred to Louth now find they are not on any waiting list in either county. One family who contacted my office applied for respite for its child over three years ago and, despite fighting its case with the HSE for years, has been told Government intervention is required to resolve it. The child is nine years old and has mental and physical disabilities. They were transferred from Enable Ireland to the HSE's disability services in Louth last autumn. Since then, they have received no respite, no home help, no physiotherapy and no speech and language therapy. The family is under enormous stress as a result. What will the Government do to resolve this and ensure every child has access to the care he or she is entitled to?

I can only imagine the stress that the family is under. I will talk directly to the relevant Minister of State at the Department of Health, Deputy Rabbitte, to ensure the specifics of the case will be looked into. With regard to every child in the country, the way the system operates and the integration of services, not just the amount of resources, often comprise a key issue. I will ask the Minister of State to look into the specifics.

Yesterday at a meeting of the transport committee, representatives of the National Transport Authority were present to discuss the greater Dublin area transport strategy. The importance of road-space allocation arose time and again regarding public transport punctuality, ensuring children have safe routes on which to walk or cycle to school, and the creation of good public spaces. What steps are we taking to support local authorities to provide more road space to ensure we address all our active-transport objectives?

It is a real challenge to meet our climate targets. One of the approaches we will take to do so will involve setting up leadership teams or acceleration task forces within key Departments, bringing together agencies, other Departments and outside experts. The first meeting of one such team, which will focus on sustainable mobility, will be tomorrow.. Critically, we will be seeking to determine what we can do in the next three years, or the remaining two years and nine or ten months of this Government's lifetime, to accelerate the delivery of active-travel infrastructure and examine the allocation of road space to achieve a modal shift, reduce emissions and improve journey times for everyone. I hope to keep everyone informed of that work. We discussed it at the national climate dialogue in Dublin Castle last month and agreed we would come back in the summer to monitor and measure progress.

The Minister and I both share a firm belief in the provision of affordable public transport, including bus services. However, we must also acknowledge that private operators have to form a part of the solution. Recent measures, including the 20% fare reduction for public transport and the 50% reduction for those with a student Leap card, are absolutely welcome, but we must include private operators in the process because, outside urban areas, these operators transport 54% of the people who need to be transported. We need to include private operators in order that their passengers also can avail of the reductions.

Another issue arises over St. Patrick's Quay, Cork city, and a change happening there that will affect the private operators. I will send the Minister a memo on that and perhaps he can come back to me.

I look forward to the details on that. The Deputy is right about the first point he made in that private coach operators have a critical role in the provision of public transport. I regard them as part of the public transport system. Prior to Covid they were expanding widely across the country, and very successful new routes were being created. Covid has obviously put a real spanner in the works but a lot of the operations kept going through the Covid period and we kept supporting them to do so.

The lower-fare card to give a 50% reduction to those under 24 will be introduced. It will take slightly longer to introduce it for private operators but it will be made available for them. It has been more difficult with the 20% fare reduction because we do not have the mechanism to monitor, manage and audit fare collection. We do not even set the prices pertaining to the private operators. I have met the coach operator organisations on this and recognise it is an issue. While there are no immediate, easy solutions, we will determine what we can do. We want the private operators to succeed just as much as anyone.

At a time when "air quality" is the buzzword being used by the Government, why are we seeing a huge increase in the waiting times for respiratory outpatient appointments? Since last October, the waiting time for a respiratory appointment at University Hospital Galway has increased from 18 months to a whopping 42 months. Nationally, there are now 18,632 people waiting for a respiratory outpatient appointment, almost 5,000 of whom have been waiting for more than 18 months to be seen. Are these delays due to the escalating number of people developing long Covid? While we are talking about air quality, the resulting respiratory problems and the ongoing effects of long Covid, why are we not getting serious about tackling this waiting list problem? Why is the HSE not using the National Treatment Purchase Fund to address these appalling outpatient waiting times?

I do not know whether those numbers reflect long Covid and its impact on respiratory illness or just the ongoing reality that respiratory illness is a significant and acute health issue in our country, which in turn means we have to address the wider issue. However, I will ask the Minister for Health to try to provide an analysis as to why the queues have lengthened and whether it is possible to use the National Treatment Purchase Fund.

I want to raise the crisis in the taxi industry. Over 2,000 taxi licences have gone after Covid, and thousands of licenceholders have not returned to work. We have circumstances in which people cannot get a taxi or face an inordinate delay when they want one. At the same time, drivers are struggling to make a living. They may be busy for a short number of hours but their business is very quiet beyond those hours. There are increases in running costs. I encourage the Minister to review the taxi advisory committee's ten-year rule and come forward with a fare increase. Is he concerned about the health and viability of the taxi industry? Will he engage with the representative groups?

My understanding is that the fare increase is out for public consultation. We differ on whether there should be a further extension. We provided one throughout Covid. If we continue to increase the age of the fleet of the taxi industry, it will become an issue for customers and the quality of the industry at a certain point. It is now time to go back to the ten-year rule.

The Deputy is right that we have lost about 2,000 taxi plates, the number having decreased from about 21,000 to 19,000.

There is a strange mix of realities, as the Deputy said. I follow very closely what is happening in the taxi industry. On the one hand, taxis are not very busy in some areas. On other occasions, people are flat out and it is difficult for customers to get taxis. We will work with the taxi regulator on an ongoing basis to make sure we get the best service and correct number of taxi drivers. If there needs to be more taxis on our streets, that might be one of the solutions.

I want to raise the issue of the Limerick northern distributor road with the Minister, Deputy Eamon Ryan. The NTA confirmed to us last week that because of his intervention this critical infrastructure for the mid-west region has been removed from the strategy. Does the Minister realised that Clare County Council is firmly behind this proposal? Does he realise that the Limerick Chamber of Commerce, and all of the chambers of commerce in Clare, are behind this proposal? Does he realise that the industrialists who provide thousands of jobs in Limerick support this road? Does he realise that this has been in the planning process for nearly 20 years? Due to his intervention, it has been removed. It is illogical. I ask the Minister to go away from this solo run and re-evaluate what he has done. The road should be reinstated in the programme. It makes sense and will deliver public transport. The Minister is looking for public transport and the road will provide that. It will link in to active travel projects on which we are spending huge amount of money every day of the week.

I fully realise what the view of Clare County Council are. I listened to every single councillor over two or three hours when we discussed this.

How many were opposed?

There are very different views within various chambers of commerce and business interests. A significant number of business people realise that success for towns and cities will now come from those which are going green and in a sustainable direction. We cannot ignore climate change. Ever onwards sprawl is not going to work for development.

Rather than the University of Limerick crossing the Shannon and going into the eastern part of Clare, we could ask it to have a satellite operation in Ennis town and bring the university into the town. I am convinced that the approach we are taking will see the likes of Ennis town and Limerick thrive, rather than a model where everything moves outwards and Clare County Council tips over to the eastern Shannon side in a way which makes it an adjunct to Limerick, rather than a strong centre in its own right.