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Dáil Éireann debate -
Thursday, 12 May 2022

Vol. 1022 No. 1

Ceisteanna ó Cheannairí - Leaders' Questions

Le gach seachtain a ritheann, tá an géarchéim tithíochta ag dul ó smacht i gcónaí. Léiríonn an tuarascáil cíosa is déanaí a d'fhoilsigh ar maidin go bhfuil an meánchíos iarrata thuas beagnach 12% ar fud an Stáit. With every week that passes, the housing crisis continues to spiral out of control. Rents are rising, house prices are rising and social housing needs continue to grow. The latest rental report published by this morning shows that the average asking rent is up by nearly 12% across the State and that 22 counties are seeing double-digit rent inflation. Rents are increasing by over 20% in counties Roscommon, Leitrim and Donegal, my county. The consumer price index that was published this morning shows that the rent paid by all private renters, including new and existing tenants, has risen by 9.3% in the past year. This is madness.

By every meaningful measure, the Government's housing plan is failing and the Minister for Housing, Local Government and Heritage is failing. His latest plan is to give developers between €120,000 and €144,000 of taxpayers' money for each apartment they build. The Minister has said that the aim of this scheme is to enable affordability for people to be able to buy and that the beneficiaries would be the public, who will be in a position, he says, to buy apartments in city schemes. On the radio this week, the Tánaiste's colleague Senator Cummins claimed that this was a subsidy for the purchaser but the reality and the kicker are as follows: the scheme the Government claims is aimed at increasing affordability explicitly rules out discounts for purchasers. It is a big payday for developers but there is zero, zilch, nada for those who desperately want to purchase affordable homes in our city. It means that purchasers will still have to fork out between €500,000 and €600,000, or more, because these apartments will be sold at market prices. Who on Earth can afford these off-the-wall prices? The Government's scheme is not about creating affordability for those on ordinary incomes. It is clear from this scheme that at best it will lock in sky-high and unaffordable prices, and at worst it will drive up housing prices even further as developers will simply price in the subsidy. Of all the pro-developer schemes that the Tánaiste and his Government have come up with, this one takes the biscuit. This is absolute madness.

The big problem with the Government’s housing policy is that all the measures it has introduced so far are driving up the cost of homes. Is it any wonder that so many people have given up, right across this city and beyond, on the aspiration of owning a home? The Tánaiste has said he believes in home ownership but he has a funny way of showing it because people are looking on at this latest scheme in complete disbelief. It is bonkers for the Tánaiste, his Government and the Minister for Housing, Local Government and Heritage to be giving €120,000 to €144,000 to developers for each apartment they deliver and not to deliver any price reduction for home buyers because that is what this is. Housing can be fixed, and this generation can have a real chance, but to do that the Government needs to turn away from the policies that prioritise the profits of developers and finally put a focus on meeting the housing needs of ordinary workers and families. I put it to the Tánaiste that the Government should scrap the scheme of handing out €450 million to developers. What about the following for an idea? What about using that €450 million to directly deliver homes that people can afford to buy?

There can be no doubt that rents are too high in Ireland and that far too many people have to spend too much of their income on rent, often at the expense of other things such as saving to buy a house, paying into a pension fund or investing in their education or that of their children. It is a dual crisis; one of affordability and availability. Sometimes when you try to improve one of those things you can make the other worse. That is why we need to be careful about the policy interventions the Government makes.

On affordability, as the Deputy knows we have brought in rent controls for most renters and the maximum increase possible is 2% in any given year. That is much lower than the rate of inflation, which is running at around 6%. The report that the Deputy referenced acknowledges that. It says that stayers, people who have stayed put, have faced a 10% increase on average since 2017. That is about a 10% increase over the course of the past four years. These are not my numbers; they are from the report the Deputy referenced. It is a different picture for new tenancies, with a 38% increase in the last four years. That is a reflection of the fact that so few homes and apartments are becoming available for rent for the first time.

I refer to what we can do around availability. We can ramp up social housing and we can provide cost rental housing, which we are doing. In social housing, we anticipate that about 10,000 new social homes will be added to the housing stock this year. That is important as it gets people off the housing list but it also frees up other properties that people may rent or buy, which can also help a lot. It started before this year but for the first time we are seeing cost rental becoming available for people as an option. That is a good option because it is Government-provided rental accommodation which people can rent at a rate that is significantly lower than the market average. That is becoming a reality for people now. It has been planned for years but it is very much an option for people now and we need a lot more of that.

We have to consider what more we can do to improve the situation. It is clear that small landlords are selling up and leaving the market. I often hear the Deputy and others make out that they are making a killing but that is not the case. If that was the case they would not be selling up and leaving. We have to look at ways to encourage small landlords to continue to rent out their properties and maybe we should encourage others to rent out properties for the first time. We also need to scale up cost rental, something this Government and I are big supporters of, and provide more cost rental units for people to rent. We have set a target of at least 2,000 cost rental units per year and we believe that is achievable. We also need to increase the supply of homes for people to buy and we are seeing some good signs in supply. We will get about 25,000 new homes built this year and that will be the highest in a long time, with 35,000 under construction and 45,000 going through planning permission. We can see an encouraging pipeline coming through in additional supply. We need to do more to fast-track the planning process and reform our planning laws to make sure more developments do not end up stuck in judicial reviews, which is a big problem. We have two affordable housing schemes coming on stream this year, one that is local authority-led and one that is private sector-led. Those will allow people on middle incomes to apply for affordable housing, which will help a lot of people to buy their first homes. In addition, we have the help-to-buy scheme where people get their taxes back, including income tax they have paid for the past two or three years, something Sinn Féin opposes. That has already helped 32,000 individuals and couples to buy their first homes. These are people who otherwise might not be in homes and would still be renting. I encourage Sinn Féin to end its opposition to that scheme.

How long has the Tánaiste been in government now? Is it ten or 11 years? Over that period when the Tánaiste has been sitting around the Cabinet table we have seen rents double. He was tweeting two years ago about how Government policies were working. He tweeted:

Rents down, homelessness down, house prices levelling off. Our policies are working.

Let me put some facts to the Tánaiste; not Sinn Féin's facts but the facts of the Central Statistics Office, CSO. In the last year rents have gone up for new and existing tenancies by 9.3%. Housing prices have gone up by 15% in the last year. In the last two years the number of people in homelessness has increased by 15%. On any viewing of those numbers, the Government's policies are failing.

We have warned time and time again, as have some within the Department and other external agencies, that the initiatives the Government is bringing in will increase house prices and push up rents further. This hare-brained idea the Minister for Housing, Local Government and Heritage has and which the Tánaiste obviously supports will give away €144,000 of taxpayers' money to developers to build apartments while ordinary workers and families will be asked to fork out between €500,000 and €600,000 for those same apartments. How can the Tánaiste stand over such a hare-brained scheme?

This Government has been in office for just over two years.


I asked the Tánaiste.

That is a fact and I can give the Deputy some more facts in a moment. This Government has been in office for just over two years. The party I lead has been in office for about 11 years. No party has been in government on this island longer than Deputy Doherty's party in the past 20 years. Sinn Féin has been in government in Northern Ireland for most of the past 20 years. I am very happy to compare our record in government over the past ten years with that of the Deputy's party. His is the party that increased rents in Northern Ireland. His party increased the property tax, which is the domestic rates system in Northern Ireland.

The public had its vote on that a couple of days ago, with respect.

The Tánaiste without interruption.

His was the party to increase the pension age in Northern Ireland.

Maybe you should stand in the next election.

Any time I tell him a few home truths about his party's record in government-----

Answer the question.

-----in Northern Ireland, he loses the rag-----

Does the Tánaiste stand over this bonkers idea of giving taxpayers' money to developers?

Deputy Doherty is out of order.

----because he does not want people to know the truth.

We know the truth.

Answer the question.

That is the record of his party in Northern Ireland. Whether it is Covid, employment, poverty-----

Look at the elections.

The largest party in the North.

-----he only has reasons to be ashamed of his party's performance in government.

Why is the Government giving taxpayers' money to developers? Answer the question.

Please, Deputy, you are out of order.

The Tánaiste cannot stand over the policy of the Minister for Housing, Local Government and Heritage on this because it is so bonkers he cannot even defend it.

I ask Deputy Doherty to resume his seat and show some respect to the House.

Maybe the Tánaiste should.

May I make a point of order?

No, we do not want any points of order.

The Tánaiste cannot even defend it.

I return to the question of the national maternity hospital. First, I thank the Minister, Deputy Stephen Donnelly, for his engagement with the Labour Party Parliamentary Party yesterday evening. We were very appreciative of the opportunity to engage with the Minister, clinicians and legal advisers to hear more about the Government's proposals, to dig into the legal documents somewhat and to hear more about the choice of the St. Vincent's site. While we did receive clarity, our concerns remain. We received much greater clarity as to why the St. Vincent's site is optimal in the view of clinicians. It is clear from the view of senior clinicians that this is almost the only site on which they might envisage that the new maternity hospital would be built.

However, this clarity just crystallised the position for us which is that if that is indeed the optimal site, the optimal approach to acquiring that site for the building of the hospital is to acquire it freehold, to ensure it is either gifted or sold at a nominal fee to the State. That is why we renew our calls today, as we renewed them last night with the Minister, for the State to consider the compulsory purchase order, CPO, option. If this is the optimal site, we need to look at the best approach on which the site is to be held. That is clearly a freehold ownership by the State. That is clear from the evidence given by the Minister, Deputy Stephen Donnelly, to the health committee yesterday where he stressed that successive Ministers for Health including the Minister, Deputy Harris, repeatedly asked the Religious Sisters of Charity and the St. Vincent's Healthcare Group to gift the land to the State but that this had been refused.

We say that the Minister should now have the courage to take on the successor company that holds the land and to seek that the land be gifted, to renew calls that the land be gifted or sold at a nominal fee to the State or indeed to take up the CPO option. The State has real history of taking up the CPO option. It is not some kind of far-fetched notion. Our colleague Deputy Howlin, who has extensive experience, has advised that this is a realistic option. It is time that we stood up to the religious orders and their successor companies. For far too long, the State has been submissive in enabling ownership of land to continue in the hands of religious organisations, and the lay-run trusts that have succeeded them in property ownership, in our school system and in our hospital system.

If we know that the optimal way to have this hospital built is on land that is owned freehold, then let us go back and ensure that that is done, that the land is gifted or sold to the State for a nominal fee. I know the health committee has sought a further short delay on the making of the Cabinet decision in the interests of further engagement to allow us to hear from further stakeholders. I ask the Tánaiste to consider that request and to consider the Government's policy by looking now at taking on the power of the religious orders and successor entities.

About two weeks ago, the Government decided to pause making a final decision on this matter. I think that was a sensible approach. It allowed people to ask questions and, in many cases, to get answers. It allowed for transparency and the publication of documents. It allowed for some people to be reassured and also allows us to consider what additional safeguards we might be able to add to the Government decision next Tuesday. I expect there will be a Government decision on the matter next Tuesday, but we will see how things develop between now and then.

Above all, we should not lose sight of what we are trying to achieve here. This is the biggest single investment in women's health in Ireland since the foundation of the State. It is part of an overall strategy to improve women's health, maternity care and neonatal care, including improvements at the Rotunda, the new Coombe hospital, a new hospital in Limerick, a new unit in Galway as well as community units. We want to achieve a world-class maternity hospital. I worked in Holles Street hospital and I know it well. It is a great hospital but it has conditions and infrastructure that are from 50 or 100 years ago.

In the new facility, every woman will have a single room en suite with the dignity that comes with that. In addition, there will be much better infection control. There will be a state-of-the-art newborn intensive care unit, NICU, for those little babies born prematurely who are most vulnerable. There will be five theatres instead of two. Think what that will do for gynaecology waiting lists. It will co-locate with a major adult teaching hospital, St. Vincent's. That means if something goes wrong, such as a woman having a major haemorrhage, cardiac arrest or stroke, within 20 minutes she can be in the ICU or in theatre in the adult hospital with all those specialists around her. At the moment women need to be transferred into an ambulance, through the streets of Dublin, out of the ambulance and into St. Vincent's Hospital. That is very much suboptimal. That is the prize. If we go for the plan in front of us, we can have that new hospital under construction as early as next year or, if not, the year after.

The CPO approach Deputy Bacik proposes does not give us that guarantee. The difficulty with the CPO, which was considered by the Government, is that we would not have the co-operation of St. Vincent's when it comes to that CPO. It would need to be a compulsory purchase, not a voluntary purchase. That would definitely mean additional costs and additional delays. At the end of it, the CPO might be refused because we would need to prove to An Bord Pleanála and to the courts that the CPO is necessary. We are being offered a 300-year lease. Deputy Bacik is a lawyer and she will know that a 300-year lease is considered to be secure title. That would make it very hard to give the women of Ireland any assurance or guarantee that the CPO would be successful. The alternative the Deputy is proposing - I understand the purity and rationale behind it - would definitely involve higher costs and further delays, and it might actually fail in the end.

We are convinced of the clinical need for the new maternity hospital; I think all of us are. All of us want the same outcome, which is a state-of-the-art, fit-for-purpose new national maternity hospital for women's healthcare in Ireland. We have heard why that should be at the St. Vincent's site. However, it is time to call the bluff of the owners of that site. It is time to call them out. While a 299-year lease is certainly better than the previous alternative that was offered of a 99-year lease, it still remains different from freehold. It still remains conditional ownership and not outright ownership in perpetuity. That is the difficulty we have. We believe it is time to call the bluff of the owners of the site and to say that we, as a State, wish to take ownership in perpetuity of the land on which the new national maternity hospital is to be built, to put beyond doubt the future ownership and future availability right into the next century of all necessary maternity and reproductive healthcare services for women. For too long women in this country have been failed by the State and by the church authorities, often working in tandem. We need to call them out on it now.

As the Deputy knows, the entire St. Vincent's campus is owned by a secular non-profit company, a charity. It has been very clear with us that it does not wish to sell the site. If the site were at the edge of the campus, like the BreastCheck building, it might sell the site as it did in the case of BreastCheck. It is very clear that this site is in the middle of its campus and it does not want to sell it. That would mean we would need to go down the route of a CPO.

It would mean they would withdraw co-operation from this project. They would cease to be partners in the project. That would absolutely mean additional cost. I cannot quantify what the additional cost would be but it would certainly be tens of millions, if not more. It would absolutely mean further delay. Instead of the hospital being under construction next year or the year after, it definitely would not be. Even at that point, the compulsory purchase order might fail, and then we would be back to square one with no hospital at all.

I appreciate the Deputy is being honest and is putting forward an alternative but I do not think it is a good alternative and I could not recommend that to the women of Ireland.

In recent months, I have held a number of meetings with organisations that provide services to people with disabilities. I acknowledge the tremendous work they do. An issue that came up with a number of different agencies was the difficulties they are having in trying to secure accommodation for clients in the rental market. I was told that most of the funding they receive is used to rent accommodation and they get very little capital funding to purchase properties. Some landlords will only rent a property for a three- or five-year period, which is causing significant difficulties as many landlords are now looking for their properties back as some want to sell to capitalise on escalating property prices and others want the property for family members.

I will give the Tánaiste a brief outline of a case that was given to me by one agency. The agency rented a four-bedroom bungalow for a five-year period at a cost of €1,600 per month. HIQA insisted that works be carried out to bring the house up to its standards and to ensure the accommodation was safe for the residents, and rightly so. It cost in the region of €155,000 to carry out those works and now the landlord wants the house back and returned to its original condition. Some €96,000 was spent on rent over the five years, €155,000 was spent on bringing the house up to HIQA standards and €78,000 was spent to revert the house to the way it was originally. That is a total of €329,000, which is a pure waste of taxpayers' money.

This is happening all over the country. These agencies, which look after the most vulnerable in our society, are finding it nearly impossible to source suitable houses in the rental market. It is a very big worry for them because they may not be able to house their clients. These agencies should be given multi-annual funding to purchase accommodation and to bring that accommodation up to HIQA standards so they can house their clients without the worry of having to move out after a few years. I am aware that some disability agencies work with local authorities and housing agencies to source accommodation but this only provides a small amount of accommodation overall.

Will the Government carry out a full audit of disability services and see how many properties are rented by them? I ask the Government to consider providing multi-annual funding so those agencies can buy and own their own houses. That would be more cost effective for the taxpayer.

I thank the Deputy. I appreciate the fact that he gave us some notice that this question would be raised because it allowed me to get some further information. Generally speaking, what the Government does is to provide funding to local authorities, charities or housing bodies either to build or purchase a house, and adapt it for people with disabilities. It makes much more sense, on many levels, that we would purchase a house and adapt it for people with disabilities or alternatively build a house from scratch, which has to be done sometimes, for people with disabilities.

On occasion, and I do not know how often it happens, a house is rented instead. The rental house is then adapted to make it appropriate for people with disabilities to live in. That is done on the understanding that the house will be leased for a prolonged period of 20, 30 or 40 years. The example that the Deputy gave is, quite frankly, something that should not happen. It sounds like a poor use of taxpayers' money that a house would be rented, adapted at considerable expense to the taxpayer and then taken back by the landlord. If the Deputy will give my office more details of that case, we will look into it because it is definitely not a good use of taxpayers' money and is far from ideal. I do not know how common that is but it is something we should and will look into.

The whole issue of housing for disabled people is now dealt with under a joint strategy of the Departments of Housing, Planning and Local Government and Health. The joint strategy was published in January and as part of that, €96 million is provided every year under the capital assistance scheme for housing. That can be accessed by approved housing bodies for housing for people with disabilities.

That was why I asked if the Government will carry out an audit of the disability sector and see how many houses are rented and what agreements are in place with landlords. If this problem is not addressed, it will continue to cause enormous difficulties for agencies trying to secure suitable accommodation for people with disabilities.

The rental market is already in crisis and not every house is suitable to meet the needs of this group of people. As I stated previously, it is a waste of taxpayers' money to adapt properties to HIQA's standards only to have to give up the property in a few years and incur the expense of returning the property to its original state.

Will the Government look at devising a capital scheme to be introduced over the next couple of years to enable these agencies to purchase their own properties? That would ensure that the homes of the most vulnerable are protected and would result in massive savings for the taxpayer.

I am dealing with Galway County Council at the moment and I know my colleague, Deputy Rabbitte, is involved. A development is taking place in a small village. I have asked Galway County Council to work with the disability agencies to build a number of houses to suit people and, in all fairness, the council has contacted Mr. Liam Hanrahan of the Irish Wheelchair Association. A number of houses are now going to be built to facilitate people in wheelchairs. That should happen a lot more.

I cannot commit to an audit but I have heard the Deputy's call for one and if he can pass on more information about the particular property he mentioned, we would be interested to know what happened and why.

In total, €96 million is available under the capital assistance scheme for housing and that can be accessed by approved housing bodies for housing for people with a disability. Funding for people with disabilities is integrated under the social housing capital delivery schemes, such as the capital assistance scheme, the social housing capital investment programme and the capital advance leasing facility scheme. The Department of Housing, Local Government and Heritage also provides funding of approximately €30 million per year to provide approximately 4,000 grants under the housing adaptation grant for people with a disability. That assists people who live in their own private homes to make their accommodation more suitable for their needs.

We have had a lot of questions this week about the national maternity hospital but I want to ask about Letterkenny General Hospital. As the Tánaiste knows, Letterkenny is part of the Saolta group of hospitals. This group has seen waiting lists increase by over 45,000 people in the past seven years. Letterkenny has seen an increase of 19% in that time, maybe not as high as other hospitals in the group but that is because we were starting from a higher base and a longer ongoing problem.

More than 2,800 people in Letterkenny have been waiting for ear, nose and throat, ENT, orthopaedics and cardiology appointments for over 18 months. There are over 1,000 patients on the three largest lists for inpatient treatment at the hospital. Indeed, we even have a situation where a consultant surgeon has been appointed but has not done any surgery because he cannot get theatre time. That is the crazy kind of situation with which we are now dealing. If it was in the film "Catch-22" we would say it was unbelievable but this is everyday life in Donegal.

Figures have shown that of 806 beds added nationally to the hospital services, only 36, or 4%, have been in the Saolta group. Sadly, I think that the Saolta group is focused on Galway and Letterkenny is at the end of it thoughts. All told, Letterkenny and Donegal are at the end of the line as far as the Saolta group is concerned and the Saolta group is at the end of the line as far as the national picture is concerned. That does not augur well for the people of Donegal who depend on Letterkenny for their healthcare needs.

Some 33% of approved consultant posts are either vacant or filled on an agency basis in Letterkenny General Hospital. The recruitment campaigns for two geriatric medicine posts were extended four times and the positions remain unfilled. A consultant microbiologist post is unfilled despite the campaign being extended seven times. The campaign for a new ENT surgeon has been extended three times. That position remains unfilled. Even if those posts are filled, we end up with surgeons who do not do surgery because they cannot get theatre time because there are not any staff to run the theatres.

What are the Tánaiste and the Government going to do about this situation? Are they simply going to continue to move patients to private hospitals or are they going to come up with ideas to sort this situation out? The people of Donegal deserve better and deserve solutions that will deal with recruitment problems. Surely the Tánaiste would agree that there is something badly wrong with a health system that does not even seem to be trying to address these problems or is it simply about forcing people onto private hospital lists?

I thank the Deputy. I appreciate that the issue he is raising is that of waiting lists at Letterkenny hospital and the waiting times for people who live in Donegal. He is also raising the wider issue of hospital overcrowding. I do not have updated information on Letterkenny with me so I do not want to give the Deputy information that may be incorrect.

However, I can speak about the general picture in relation to what the Government is doing to reduce waiting lists. We do acknowledge that there are far too many people waiting on healthcare for far too long. Even before the pandemic this was an issue but of course, it has become a much more serious issue because so much care was delayed, and had to be delayed, as a consequence of the Covid-19 pandemic. That was further affected by the cyberattack on the HSE. The Government has a plan to reduce waiting times considerably. We have set aside a dedicated budget for this plan of €350 million per year. It is a huge budget to implement the waiting list plan and that will go to public hospitals and also to private hospitals, where appropriate. We need to use whatever capacity we have to get people the treatment they need. If the waiting list plan works then by the end of 2022 the number of patients on active waiting lists will be at its lowest point in five years. I cannot guarantee that is going to happen but that is the plan we are working on. If it does happen, it will be a minor achievement, at the least, to have waiting lists at their lowest in five years by the end of this year. That is the Government's objective and of course, that applies to Donegal and Letterkenny as well.

We will offer treatment to all 75,000 patients on the active inpatient and day case waiting lists at the end of 2021 by the end of 2022 and will ensure that 1.7 million people are removed from waiting lists for scheduled care in 2022. In addition, we are expanding the capacity in our existing hospitals. There are between 800 and 1,000 more beds in the system than before the pandemic and we are continuing to add to that. We need to do that because we have a population that is increasing and aging all of the time, with the additional healthcare needs that come with that.

There is no need for the Tánaiste to provide up-to-date figures on Letterkenny. I gave the up-to-date figures in my opening remarks and they show the seriousness of the situation. Unfortunately, even if the Government's plan works, it will not solve any problems in Letterkenny because what needs to be addressed there is the recruitment and retention of consultants and of ancillary staff to allow those consultants actually to do their jobs. That is the reality.

The Irish Hospital Consultants Association, IHCA, has said that the maintenance of the FEMPI wage cuts is causing the problem of the recruitment of consultants. Reversing those cuts might go some way towards alleviating the problem. I also suggest that there is an alternative, which is to do a deal to recruit Cuban doctors into the Irish medical system. This has been working in Portugal and Sweden, both of which are in the EU. Cuban doctors are working in both countries and are alleviating some of their recruitment problems. We should do that now, as another step to try to deal with this issue.

For years to come, the pandemic and the cyberattack are going to be used to explain why we have not delivered but that is not good enough any more. Even if we deal with these issues, Letterkenny will be back in the same situation it was in prior to the pandemic.

It is an enormous challenge to recruit and retain healthcare staff, including doctors and that is not unique to Ireland. That is very much a global phenomenon. There is not a health service that I am aware of, certainly not in Europe, that does not have a difficulty recruiting and retaining staff. There is much more demand for healthcare than there are qualified doctors, nurses and midwives in the world. That is why, just like lots of other countries, we rely so much on people coming from overseas to help to staff our health service. We are very grateful that they come here and do that. I do not have exact details on Cuba but I certainly do not see any reason why somebody in Cuba could not apply for a work visa to come here and work in our health service.

We should acknowledge, and this is not often acknowledged, that we have more doctors working in our public health service than ever before. One would get the impression sometimes that the number of doctors in our health service was going down and that more people were leaving than were coming in but that is not the case. We have never had more doctors working in our health service than we do now. We have never had more staff in our health service than we do now. We are up to about 40,000 nurses and midwives in our public health service now, which is more per head and more per bed than almost any country in the western world. That is part of the story and it should be acknowledged. Yes, we do have a recruitment and retention problem and it is a big one. We are struggling in that area, as are lots of other countries but we do have record numbers of doctors, nurses and midwives now working in our health service.