I want to put on the record that I have written previously to the Ceann Comhairle about the Minister or Minister of State responding to Topical Issue debates. I mean no disrespect to the Minister of State, Deputy O'Donnell. My understanding has always been that if the Minister was not available, we would be advised of it in advance or a Minister of State from that Department would come to the House. I wrote to the Ceann Comhairle on the previous occasion this happened. It was on the same issue and here we are again.
Saincheisteanna Tráthúla - Topical Issue Debate
Hospital Inspections
I am on duty for all of the Topical Issue debates and it is nothing in particular.
No disrespect is meant to the Minister of State.
I appreciate that.
I want to put on the record that no disrespect to the Minister of State, Deputy O'Donnell, is intended. I will be writing to the Ceann Comhairle again. We should have received notification that neither the Minister nor a Minister of State from the Department of Health would be here. This is the second time in a row this has happened to me.
As the Minister of State is aware, on Friday, 23 June, HIQA published its report of an unannounced inspection that took place at University Hospital Limerick on 21 and 22 February. Its previous report, following a visit on 15 March 2020, was damning. Of the four major categories, that report found the hospital to be partially compliant in one category and non-compliant in three. Last week's report is an improvement but things could not have been any worse. Some actions have been taken to address the failings found in the June 2020 report but the report is of concern with regard to patient safety and dignity. In the 15 subcategories listed in last week's report, University Hospital Limerick was found to be fully compliant in only one area, substantially compliant in seven areas, partially compliant in five areas and, worryingly, non-compliant in two areas.
One of the positive aspects of the report is with regard to the staff at UHL. The patients spoken to by HIQA were extremely complimentary about the staff. I thank the staff for the incredible work they do, often in a difficult environment. For those who have relatives, friends and families attending the hospital, the feedback will come as no surprise. In the main the staff are professional, courteous and kind, and this is no easy accomplishment when we consider the overcrowded working conditions in which they operate. The challenges facing UHL staff were noticed by the patients, who remarked to the report authors that there were not enough staff and the staff were overworked. The staff can do only so much. There are not enough of them to cope with demand in the hospital. The hospital remains significantly short of non-consultant hospital doctors, with the University Limerick Hospitals Group acknowledging that a further 68 are needed.
The HIQA report found that on 21 February the emergency department was over capacity by three times the recommended number of patients who can be assessed safely. By 11 a.m. on that day there were 121 patients in the emergency department, which has an intended capacity of 49 people. An additional 72 people were being accommodated on trolleys and chairs. While this is no surprise to many, it is an atrocious situation to have an emergency department operating at 153% of its safe capacity. The day of inspection, 21 February, was a Tuesday and not a Saturday or Sunday when a large influx of presentations might be anticipated. The HIQA report found that on the day of inspection, 60% of attendees in the emergency department were still there after six hours, 48% were there after nine hours and 20% were there after 24 hours. At 11 a.m. on the day of inspection, the hospital was not compliant with any of the national key performance indicators set up by the HSE for emergency departments.
The report went on to note, as I have highlighted many times in the Chamber, that the persistent overcrowding is not only an affront to patient dignity but is dangerous and places challenges on staff in ensuring the cleanliness of clinical areas in the hospital, the separation of patients and limiting the spread of infection. Overcrowding at the hospital is not a new phenomenon. The hospital has operated an emergency protocol every day this year apart from two days. As the INMO stated in response to the report, we need to see a laser-like focus from the Government and the HSE on tackling the overcrowding crisis once and for all. Can we expect a response from the Minister for Health whenever he turns up?
I thank the Deputy for raising what is a significant issue for the people of Limerick and the mid-west and for all of us who represent them in the Oireachtas. I welcome the opportunity to address the issues in the HIQA report. As the Deputy is aware, in February, HIQA inspected University Hospital Limerick against the national standards for safer and better healthcare. The inspection assessed compliance with 11 national standards. The inspection team visited several clinical areas throughout the hospital, including the emergency department, the trauma ward, and the acute medical unit.
While more has to be done, there have been some improvements. A geriatric medical unit has been established in the emergency department for those aged over 75 years. There has been recruitment of additional staff, including two emergency department consultants, bringing the complement to 11, and 20 non-consultant hospital doctors. There has also been recruiting for nursing and other areas. A total of €6 million has been provided to deal with issues raised in the previous HIQA report. Many of the initiatives have been in place only since January. There have been some improvements and HIQA would like to see a lot more.
We have seen the time patients are in the emergency department decrease by approximately an hour but it is still way off what we would like to see. The report stated the fundamental issue is capacity. This is borne out by the fact the acute medical unit and the acute surgical assessment unit were re-established. What the report states is they have not worked to date. A total of 55% in the acute medical unit were waiting for an inpatient bed, as were 25% of those in the acute surgical assessment unit. More particularly, 24% of those presenting to the emergency department will be admitted to inpatient beds but 45% of those in the emergency department were awaiting admission.
A total of 40% of people in the ED are awaiting admission, which shows the capacity constraints. We have looked to address that, as the Deputy will be aware. The 60-bed modular block has been built and a further 38 beds went in during Covid, bringing the total to 98. A 96-bed block is under construction and is expected to be in operation in early 2025 and a further 96 beds on top of that second block are being advanced. The Minister has given approval for UL to advance the design of that project alongside the existing 96-bed block. Between them, that is nearly 200 beds, which will make a huge difference.
The HSE, in conjunction with UHL, has developed a compliance plan and makes reference to a number of aspects within it. In the acute medical unit in Nenagh, there will be a doubling of the beds, from six to 12, bringing the overall figure from 32 to 38 between the hospitals in Ennis, Nenagh and St. John's, at 18, 12 and eight, respectively. An acute medical assessment unit will have been relocated alongside the ED by October, and there has been a request for a review of the acute surgical assessment unit by the same month.
The Deputy spoke about compliance. That comes down to the compassion and kindness of the staff for patients, and HIQA was glowing in that regard in its review. It is going to review the space, with a view to providing an additional 16 nurses and a further five-----
I thank the Minister of State but his time is up. He will have a chance to come back in.
I thank the Minister of State. I am on record as saying I acknowledge that work is being done at the hospital, with a 96-bed unit being built as we sit here. Nevertheless, that will deliver only 48 additional beds, as the HSE itself has stated. Single-occupancy beds would be the better way, not least because our hospital has suffered over the years from infections and cross-contamination, so that would be useful. Two other 96-bed projects are in the ether but we do not know their status. I do not believe the Government has at its heart the ability, willingness or will to solve the problem at University Hospital Limerick. The overcrowding has been going on for years. The UL report stated the hospital needed 302 additional beds, not 96 or 48, by 2030.
The slow delivery we are seeing means we are condemning the people of Limerick and the wider mid-west to suffer overcrowding in the hospital for years to come, with no plan whatsoever to get us out of the situation we are in. There is a crisis in home care and people in hospital have been occupying beds for days while simply waiting for an MRI scan. These issues can be resolved. We all know about them, and families, friends and nurses will have told us about them. Consultants have rung my office in despair, asking me whether I can somehow speed up an MRI scan because they cannot seem to get it done themselves. All that nonsense is going on while we wait for the units to be built. There are three 96-bed units and I assume all of them will equate to 48 beds fewer in the system. As I said, that is good but it will not deal with the capacity. The number one issue relates to the catastrophic mistake made to close the emergency departments without delivering a centre of excellence in our local hospital, and we are all suffering the consequences of that in Limerick and throughout the wider mid-west.
I ask the Minister for Health, who might listen to the debate or read the Official Report, and to whom I will write about this, to intervene personally and speed up the process. This cannot keep going on the way it is.
The Deputy can be in no doubt the Government considers dealing with the issues at UHL a top priority. The Minister will go to Limerick on Friday and visit Croom hospital and UHL, specifically because the priority is being directed very much towards the latter. Improvements have taken place. The medical assessment units are now open seven days a week and an additional six beds will go in. Furthermore, a report commissioned by the hospital group itself yesterday referred to 300 beds, and the more beds there are, the better. The HIQA report states there is a shortage of 200 beds. There is the 96-bed block and HIQA is saying it is split 52:48, although I think that is a moot point.
HIQA stated in the report that it would like to see something done immediately with some of the existing wards to improve their quality, and that is something I am going to pursue with UHL along with the Minister. Moreover, the 96-bed block on the grounds of UHL is under construction, while the second 96-bed block will be located directly beside it. UHL will carry out some works on that as part of the current 96-bed blocks and then will put forward design and planning to the Minister to proceed with the second 96-bed block. Between them alone, that is 192 beds, with the second 96-bed block expected to have been finished by 2027.
When I read the report, I see a lot of things need to be done, including the additional recruitment of staff. There are now ED consultants there between 8 a.m. and 8 p.m. midweek, and 8 a.m. to 1 p.m. at the weekend. I would like to see whether we could increase those hours under the new contracts. Fundamentally, the Government is utterly committed, as am I as a Limerick City Deputy, to ensuring we get sufficient capacity into UHL.
Hospital Inspections
I thank the Minister of State for attending, although he does not have responsibility for justice issues. I accept that occasionally happens during the Topical Issue Debate but I would nonetheless like a comprehensive response both from the Department of Justice and from him. I wish to discuss the increase in the number of assaults in Dublin, which is multifaceted, so his Department, which has responsibility for local government, comes into play, which I will come to in a moment.
The most recent assault in Dublin we all heard about was the vicious assault of Oleksandr Hrekov. Oleksandr is a member of the Lesya Ukrainka National Academic Theatre, which was invited here to take part in performances of Brian Friel's Translations at the Abbey Theatre. It was successful, as it should have been, and very empowering for all those involved. Translations is, of course, a story of endurance, perseverance and culture. Following one of the performances, Oleksandr and other members of the cast left the theatre and walked up the street. They were pursued and Oleksandr was asked for a cigarette and then assaulted with a broken bottle. The images that were released of Oleksandr's injuries would turn the stomach of anybody in that a person could be welcomed here from a war-torn country such as Ukraine for a cultural endeavour and then experience a vicious assault of that nature.
What those of us who live and work in this city could not step away from was the fact that, as disgusted and revolted as we were, we were not surprised. Violent assaults in Dublin have increased dramatically over recent years, with the number of assaults up by 60% in the south-central Garda division and the number of serious assaults up by 90%. We have a very serious problem in this city, and I love this city, which is why I am standing up for it here today. We need to get in front of this. Of course, a Garda response needs to take place, and there is an issue for the Minister of State's Department regarding how the city feels when you see the level of dereliction, the absence of street lighting, the shop vacancies and the fact that when it goes dark, you are better off taking yourself away from it because it is just not safe for many people. We need a collective response from the Government, local authorities, Garda members and health agencies. Dublin is a beautiful capital city full of all the glory I associate with it, including vibrancy and friendly people, but that falls away on certain streets around O'Connell Street and elsewhere in the city centre such as Temple Bar at night, when it becomes unsafe. I understand we can pull out statistics to say that, actually, the number of incidents has fallen, but anybody who works or lives in the city knows we have to do better.
I am interested in hearing the response of the Government. I raised the specific issue of Oleksandr Hrekov because it was stomach-churning, but it is reflected in a broader sense in other people's experiences. I have raised in the House on numerous occasions the issues relating to Dublin city. What is the response?
Has the Minister of State contacted the Garda Síochána? Will he engage with local authorities? I am interested in hearing his response.
I thank Deputy Gannon for raising this issue, which I am taking on behalf of the Minister, Deputy McEntee, today.
I join Deputy Gannon in condemning the despicable attack on Oleksandr Hrekov. The group was on a tour from Kyiv and had come over to do ten nights of Brian Friel's Translations. It was a very positive endeavour. Oleksandr has returned to Ukraine. I send our best wishes to him. It is something that is not reflective of what Irish society is about. I wish Oleksandr a speedy recovery, as does the Minister, Deputy McEntee, and the Government. We urge anyone who has information about this despicable act to contact An Garda Síochána.
Deputy Gannon will appreciate that while I cannot comment further on the incident as there is a Garda investigation ongoing, I want to emphasise that the Government is determined to tackle criminality and antisocial behaviour and is very conscious of the impact serious assaults can have on the quality of life for local communities, including in Dublin city centre. That applies to both people living there and to tourists and businesses. As Deputy Gannon outlined, Dublin is a hive of business and tourism, as are many other areas of the country. Equally, there is a strong community created by local residents. We want Dublin city to be a safe place for people to live, work in and visit. Dublin city is our capital and we are all very proud of it.
The Government is committed to taking action to tackle crime throughout our country. We are giving An Garda Síochána the tools and technology to fight crime in a digital era by rolling out improved CCTV and body-worn cameras. We are doubling the maximum sentence for assault causing harm to ten years. We are giving local people and local representatives a real say in how to make their communities safer through the new community safety partnerships. We are introducing the Garda powers Bill to modernise and update the powers available to An Garda Síochána. The Bill is currently being drafted. The Government is also investing significant resources into An Garda Síochána to provide for sustained and ongoing recruitment as well as investment in equipment and capital.
Deputy Gannon will appreciate that it is the Garda Commissioner who is responsible for the distribution and deployment of Garda resources. He shares the Government's commitment to building stronger, safer communities and ensuring our capital city is a safe and attractive place for everyone.
I am assured by the Minister, Deputy McEntee, that the distribution of gardaí is kept under review by the Garda authorities in light of any emerging crime trends or policing needs. An Garda Síochána maintains a proactive approach to policing the city centre to reduce crime and keep people safe. There are a number of important Garda operations in place in Dublin, but given the limited time I will not outline them all. I expect Deputy Gannon is aware of Operation Citizen, which commenced in 2021. It is delivering an enhanced policing presence in Dublin city centre. Members of the Garda mounted unit are involved as well. Operation Limmat is the Dublin metropolitan region's public order reduction strategy. Operation Saul is intended to further support and strengthen the strategic and operational objectives of Operation Citizen.
As Deputy Gannon is also aware, in addition to proactive policing operations in Dublin city centre, a new Garda station on O'Connell Street was opened in March this year, providing An Garda Síochána with a strategically located central hub on Dublin's main thoroughfare to enhance Garda visibility and engagement in the inner city. The new Garda station has a public office for members of the public to seek support and report crimes and to provide support to victims of crime. It also serves as a hub in which on-duty gardaí can report to directly.
The Minister of State will get a chance to come back in.
Deputy Gannon can read the rest of the reply. The points he makes are very consistent. I await further comments from him. I will respond to the points relating to local government in my next contribution.
I thank the Minister of State for his response, which from the perspective of the Minister, Deputy McEntee, is quite comprehensive. I fully appreciate there are a number of different plans in place, including Operation Citizen.
The Minister of State mentioned that the Garda Commissioner states the distribution of gardaí is often considered and monitored. I vehemently argue that policing in an urban environment, in particular a city centre environment, is different from policing anywhere else in the country. There are very different needs and it requires very different skill sets. We need a consistent Garda presence in the city centre that is not going to be reallocated to other areas based on, for example, protests happening. Of course we need gardaí to manage them, but we need a consistent Garda presence in the city centre that is always there, without the number going up and down, because policing there is different.
I have seen that the Garda station on O'Connell Street is open but I do not think there has been a significant increase in gardaí on the street. There is a physical building there but locals have not seen a difference in that regard.
I want to ask the Minister of State about local authorities, in particular as they come under his remit. At times, Dublin is a dirty city. I do not know what the situation is in regard to street cleaning at the moment, but if you walk around the city centre on any given weekday, it does not look clean. Dereliction is a massive problem. The environment around Dublin presents itself as being hostile. In addition to dereliction, there is an absence of street lighting and vacancy. I do not want to present this picture of the city because I love this city and there is nowhere else in the world I would rather be, but we cannot step away from the fact we have problems. I believe a multifaceted approach is needed. Has the Minister of State called in the management of Dublin City Council and asked what is happening in Dublin? We all realise the city has gone into a decline. What has his engagement been with the local authority?
I will feed back the points Deputy Gannon raises on policing to the Minister for Justice, Deputy McEntee.
I will make a couple of points on local government. All local authorities are responsible for the management of their areas. They are independent in terms of the area they look after. The reserved powers of councillors are hugely important as well. On the issue of dereliction, Deputy Gannon will appreciate there are Croí Cónaithe grants for individual properties but, more particularly, there is funding from the urban regeneration and development fund, URDF, for each local authority.
I am relatively recently in this role, and I am going around to all the local authorities. My focus is specifically on dereliction, URDF funding, vacancy, and all the basic elements of improving the state of villages, towns and cities. I will follow up with the incoming manager in Dublin City Council and raise these points. Has Deputy Gannon raised the issue of street cleaning with Dublin City Council? If he wishes to write to me on those specific issues, I will take them up. I am systematically going around to all the local authorities, and I will make it a priority to visit Dublin City Council. Will Deputy Gannon tell me what the issues are now so that I can follow them up with immediate effect?
Pension Provisions
I will be very brief. I appreciate that the Minister of State, Deputy O'Donnell, is not the line Minister and is taking this matter on behalf of others. I have been contacted by former An Post workers who are pensioners who tell me that, in March of this year, the Workplace Relations Commission, WRC, the Communications Workers' Union, CWU, An Post and the Government reached agreement on an increase of 5%, to be backdated to 1 January 2022, with a further 2% from 1 January 2023 and 1% from 1 July 2023. I am told by the people who have contacted me that no payment has been made since the agreement was reached. I am also told the payment only requires a ministerial signature from whichever line Minister is responsible. In this case I assume it is the Minister for the Environment, Climate and Communications, Deputy Ryan, and the Minister for Finance, Deputy McGrath. All we are advocating for here is on behalf of those who are on meagre pensions and who have now an entitlement by virtue of the agreement that was reached. The simple question is when they will be paid.
These payments are now delayed and they need to be paid. They speak to a fundamental systematic problem with how this pension is being run. This dates back to section 46 of the Postal and Telecommunications Services Act 1983. Back then, the workers were Civil Servants. The terms of this Act were to ensure that it was a clear wish that all sides if necessary should guarantee transferred staff that their tenure of office and security of employment would be as good, strong and safe as in their present Civil Service capacity and that the terms of their pension would never be less than the Civil Service pension, that they should always be benchmarked against that. That is in the 1983 Act. Therefore, any worker who divested on the divestment date of 31 December 1983 should be protected. The superannuation scheme itself came into being in 1990. Since then, even though the Act itself has been amended over 100 times, nothing has diminished what section 46 says, which is that the pensions of the workers should not be less than a Civil Service pension and workers should not be treated any less favourably than their entitlement by reference to the Civil Service regulations that were enforced on 31 December 1983.
There has been advice from Attorneys General on this. There has been ombudsman commentary on this. There has been independent legal advice on this. These workers, who are now pensioners, are being left behind in an inflation and cost-of-living crisis. They are on low, fixed incomes. They are not entitled to a State pension due to the terms of their pension. Therefore, these workers do not get any double payments or any measures that the Government has brought in through the social protection system. They do not get those benefits. This is a structural problem which should be resolved and the Minister has the power to do it.
I want to thank both Deputies Sherlock and Duncan Smith for raising this matter, which I will take on behalf of the Minister for the Environment, Climate and Communications, Deputy Eamon Ryan.
I want to outline the position on this matter, which deals with the current increases that are formally due. Under section 46 of the Postal and Telecommunications Services Act 1983, the Minister for the Environment, Climate and Communications, with the concurrence of the Minister for Public Expenditure, National Development Plan Delivery and Reform, approves any superannuation schemes that are submitted by An Post. The operation of the schemes is a matter between the management of An Post, staff representatives and the trustees of the schemes.
As Deputy Sherlock stated, on 9 March 2023, An Post wrote to the Department seeking consent to the second phase of their current pay agreement which provides for a 2% increase in pay from 1 January 2023. In addition to this, on foot of a recent Labour Court decision, An Post wrote to the Department on 9 March seeking approval to make increases to pensions in payment and deferred pensions of a 5% increase from 1 January 2022 and a 1% increase from 1 July 2023.
In addition to the requests that I have referenced, An Post also wrote to the Department on 20 June 2023 seeking approval to increase pensions in payment for members of the An Post superannuation scheme who are aligned to the Principal Officer, PO, grade in the Civil Service.
In accordance with the relevant code of practice from the Department of Public Expenditure, National Development Plan Delivery and Reform, An Post must seek ministerial approval to increase pensions, as the Deputies have both stated, for deferred pensions for members of the An Post superannuation scheme. As per circular 16/2021, all such proposals require the view of NewERA, as well as a business case setting out the strategic policy and financial rationale of proposed increases. Circular 16/2021 states that pension approval requests should be submitted for approval well in advance of any decision to implement changes and acknowledgement of the necessary process that must be completed. In order to ensure that pension increases are not unduly delayed, it should be recognised that the time taken for the pension approval process is necessary to ensure that robust governance procedures are in place.
Following receipt on 9 March, An Post's request to the Department of Environment, Climate and Communications, the standard process is now being followed with NewERA’s views and an assessment by the officials being required prior to the consent of both Ministers being sought. The most recent request on 20 June has also been forwarded to NewERA. This is the same procedure that must be followed by any State body. Consideration of the consent request of 9 March is well advanced and a report from NewERA is expected shortly. It is not possible at this point to specify a timeframe within which this decision-making process will be concluded. However, the Deputies are raising points on behalf of the An Post pensioners. It is a matter I will take back to the Minister, Deputy Eamon Ryan. I will ask that the matter be given full consideration in terms of looking at having these payments made as quickly as possible.
I appreciate the fact that the Minister of State, Deputy Kieran O’Donnell, is taking this matter on behalf of the Minister, Deputy Eamon Ryan. I think the answer, with respect to the Minister of State, is inadequate because it does not give a definitive timeline for which those monies will be paid. Ministerial approval is the benchmark here. That is the yardstick. That is the point that we need to get to. I understand that consents have to be sought and I understand that there is a process with New Era. However, we are not talking about thousands of people here. We are talking about a small cohort of people. In terms of the State, the Departments and the Government, this requires ministerial intervention at senior Cabinet level. I ask for that to be done.
I thank the Minister of State for his response. Again, I agree there is an inadequacy to it. I also will need to take back the information, which is new to me, about how An Post wrote to the Department for the superannuation scheme to be aligned with the PO grade in the Civil Service. I just want to go back and have a look at that. While NewERA and the Department of Environment, Climate and Communications etc. may be reviewing these requests, they have ultimately to be bound by section 46 of the Act. This discretion has been applied by the Minister to pension increases when they should always be pegged against section 46 and on terms that are not less favourable than Civil Service terms. That has not been done. That is a structural problem that underpins the problem we are raising here.
We have a pension problem in this country. It is not a time bomb coming down the road; it is here right now. There are pensioners who are on low fixed incomes now who cannot afford to get by. Age Action, the National Women's Council, Active Retirement and SIPTU yesterday launched the Pension Promise campaign. It is right throughout society. The An Post workers are another aspect of that. I ask the Minister to come back with a real resolution to this.
I thank Deputies Sherlock and Duncan Smith for raising these matters on behalf of the An Post pensioners. They will appreciate that there is a process. NewERA is part of that process, and the issue is currently with NewERA. However, I do take their point that this process should be concluded as quickly as possible. I undertake to go back to the Minister, Deputy Eamon Ryan, to make that point. I suggest that the Deputies would follow up directly with the Minister, Deputy Eamon Ryan, themselves as Members of the House.
With all due respect to the Minister of State, one would expect that if he is to address the Minister, Deputy Eamon Ryan, then the Minister, Deputy Ryan, would respond. I say this with respect to the Minister of State.
I was trying to be helpful to colleagues. I appreciate there is frustration on the part of the pensioners. However, there is a process there. The point that Deputy Duncan Smith raises about section 46 is a matter that I am not hugely familiar with. However, it is a matter I will take back to the Minister, Deputy Eamon Ryan, as well.
The next Topical Issue is not in a position to proceed, but we will wait for a few minutes just in case.
Cuireadh an Dáil ar fionraí ar
9.51 a.m. agus cuireadh tús leis arís ar 10 a.m.
Sitting suspended at 9.51 a.m. and resumed at 10 a.m.