Dáil Éireann debate -
Tuesday, 3 Oct 2023

Vol. 1043 No. 2

Saincheisteanna Tráthúla - Topical Issue Debate

Foreign Conflicts

Deputy Patrick Costello

On 12 December 2022 we saw the closure of the Lachin corridor, a small humanitarian corridor which was the only route into the Republic of Artsakh, in which ethnic Armenians live. This was closed by the Government of Azerbaijan. This act of closing the Lachin corridor was described by the International Court of Justice as a breach of international law. It also flew in the face of well-established European Court of Human Rights norms on collective punishment. The closure led to a cruel and deliberate forced starvation of a civilian population. There was the denial of food and medication. As I have said, it was collective punishment of an innocent civilian population that was left to rot and starve in scenes reminiscent of the Armenian genocide of 1915. This is a genocide that we refuse to recognise in this country, despite many other countries moving to this way. Many of the countries that had diplomats there at that time described very clearly the genocide.

In recent weeks, unbelievably, this situation has managed to get worse. We have seen open attacks on civilian populations. We have seen 100,000 people displaced in what is essentially ethnic cleansing. In the war in the Nagorno-Karabakh area in 2020, the Azerbaijani Government proceeded to scrub any evidence there had ever been an Armenian culture in areas that they captured. Churches that dated back to the 4th century, some of the earliest Christian churches anywhere in the world, were wiped out. They were simply reduced to dust that was left to blow away. This is more than ethnic cleansing. This is an attempt to eradicate not only an entire people in a region but also any record or any history that they were there, including their churches, their writing, their culture, their buildings and their homes. They were all utterly demolished.

What we saw in the war in 2020 was barbaric treatment of captured soldiers and captured civilians. We now have an International Court of Justice ruling that clearly states what we are witnessing is a breach of international law. We have European Court of Human Rights interim measures from September that ordered Azerbaijan to refrain from collective punishment and to respect the right to life, something the Azerbaijani Government has utterly failed to do.

We have moved beyond ethnic cleansing. Once again we are moving into the realm of genocide. It is not only about destroying the people who are there but destroying any memory that they were even there to begin with. What will we do to uphold international law? We have two rulings, which is a rarity in these situations, from the International Court of Justice and the European Court of Human Rights. What will we do to make international law real? Will we say that crimes of aggression are totally acceptable if the country is providing us with gas? What will we do to provide help and support for those people who have been internally displaced? There are 100,000 people who are starting their lives afresh.

Minister for Foreign Affairs (Deputy Micheál Martin)

I thank the Deputy for raising this very important issue. The situation in Nagorno-Karabakh remains a matter of the gravest concern, particularly in light of the fallout from the military action initiated by Azerbaijan in the region on 19 September. Ensuring the welfare and protection of civilians who remain there, as well as of those who have fled to Armenia, including through the facilitation of humanitarian access where there are needs, remains at the core of Ireland's response.

We continue to co-ordinate closely with our EU partners in this regard. These most recent developments follow a particularly difficult and traumatic ten-month period during which the movement of people, goods and vehicles from Armenia to Nagorno-Karabakh via the Lachin corridor has been obstructed by Azerbaijan. This land corridor was considered a lifeline for the Karabakh Armenians. I emphasised Ireland’s concerns regarding the impact of the ongoing obstruction of movement on civilians during my call with the Armenian Minister of Foreign Affairs, Mr. Mirzoyan, on 11 August, which he sought.

The situation has since deteriorated, as the Deputy said, following Azerbaijan’s military escalation on 19 September. Ireland has been vocal in its condemnation of this action, amplifying the respective statements of High Representative of the European Union for Foreign Affairs and Security Policy and Vice-President of the European Commission, Mr. Josep Borrell, on 19 and 21 September, and co-ordinating closely with our European Union partners in the Council of Europe, the Organization for Security and Co-operation in Europe, OSCE, and at the United Nations. We also expressed our concerns regarding the situation in our national statement at the Human Rights Council in Geneva on 26 September.

There have been recent meetings between Baku and the Karabakh Armenians, and we reiterate our call for a genuine, comprehensive and transparent dialogue to ensure that the rights and security of the Karabakh Armenians are protected. I also welcome that a United Nations mission arrived in the region on 1 October to report on the situation.

We are all particularly alarmed at reports of the mass exodus of Karabakh Armenians that is currently taking place from the region, with more than 100,000 of the 120,000-population reported as having left Nagorno-Karabakh for Armenia to date. It is heartbreaking to see men, women and children of all ages leaving and taking what they can from their homes with them.

Azerbaijan bears responsibility for the rights and security of the local population, including the right to remain in their homes without fear of intimidation as well as the right to return for those displaced. Ireland is actively supporting the humanitarian response through the Start Fund and People in Need, whose representatives are on the ground assisting vulnerable people displaced by the conflict in Nagorno-Karabakh. Ireland’s support will ensure people fleeing Nagorno-Karabakh have access to essential basic goods and services. Ireland also provides significant core funding to the United Nations High Commissioner for Refugees, UNHCR, and the International Committee of the Red Cross, ICRC, which are playing a large part in the response.

The European Commission has announced an additional package of humanitarian aid of €5.2 million on top of the €20.8 million already provided since 2020 to support vulnerable people remaining in Nagorno-Karabakh, and those who have been displaced. The European Union is also playing an active role in efforts to resolve the long-standing conflict in the region. European Council President Michel has been personally involved in efforts to de-escalate the situation.

On 26 September, the European Union facilitated discussion between Armenian and Azerbaijani officials with a view to preparing for the next meeting at leader level, which we hope will take place as soon as possible. We hope that this week’s meeting of the European Political Community may provide an opportunity to advance diplomatic efforts. Ireland fully supports President Michel and EU Special Representative Klaar in their efforts to facilitate dialogue to build a lasting, comprehensive peace in the region. Ireland also fully supports the European Union mission to Armenia, which was established in January of this year. The mission is tasked with monitoring the situation in conflict-affected and border areas in Armenia to reduce the level of risks for the population and to contribute to the normalisation of relations between Armenia and Azerbaijan on the ground.

Deputy Patrick Costello

The news of funding and the humanitarian aid and effort is very welcome, and I know it will go a long way on the ground. It highlights another issue in that now there is a UN mission on the ground where there was not before and the UNHRC is getting involved whereas before there was a threadbare presence from the Red Cross. That was essentially all that was able to get into the region, which allowed Azerbaijan to be able to escalate its violence and brutality.

One of the things I find frustrating around this is essentially the double standard. The Minister will have heard this from many Deputies in this Chamber with regard to Palestine but, certainly, we have here a country that has committed a crime of aggression, deliberately targeted civilians, starved them and denied them medication. It is committing ethnic cleansing and has perhaps even gone so far as genocide given that it is wiping out even any memory of these populations. They are wildly corrupt. The Azerbaijani laundromat has undermined European democracy as well. It is all about hiding internal human rights abuses. Yet, I doubt we would give the Russians, who have been at similar things, a warm reception in this Chamber. It is quite frustrating when we see the Azerbaijani Government committing the exact same breaches of international law and human rights abuses being given a warm welcome here.

Ultimately, though, we need to get more involved in this region, whether that is through us or through our European Union colleagues. This region is a neighbourhood of ours. It is a region that has been deeply troubled and destabilised through Russian efforts in many ways. Armenia itself is a country that seeks to build deeper relations with Ireland and trade with Ireland and the European Union. I would welcome if the Minister could perhaps give us an update after these various EU meetings at which there will be discussions both in meetings with European colleagues and, I understand, at side meetings as well. The Minister might come back or write to me afterwards with a further update with regard to those.

Deputy Micheál Martin

I thank the Deputy for raising the issue. Our priority is and will remain the safety of the local population and the humanitarian situation on the ground. Our focus right now is on doing that as best we can. We call for full compliance with international humanitarian and human rights law. The issues the Deputy raised in terms of the protection of civilians are still open to countries to take action on in respect of international accords and various accountability measures.

On 23 October, there will be a further meeting with the EU foreign ministers. The EU has been very genuinely engaged in trying to prevent all this from happening and, unfortunately, that has not been successful. At the very first European Political Community meeting, as it is called, President Macron brought both the Presidents of Azerbaijan and Armenia together early in the morning. He thought he had a resolution at that stage or a cessation and some pathway to peace. The President of the European Council, Mr. Charles Michel, has been brokering with President Macron attempts at ceasefires and resolution of the conflict. Unfortunately, the European Union has been clear with Azerbaijan that there should not have been an escalation and that it should not have done what it did. There is no question, of course, that it was shocking. There was no need for that brutality against the population of Nagorno-Karabakh.

The issue was discussed at the meeting of the permanent council of the OSCE, which has always had a standing brief here. We met with the OSCE recently. There was a meeting on 28 September in Vienna and the meeting of the European Union's Political and Security Committee was held in Brussels earlier today. There are ongoing meetings. I know the French minister is on her way there as well. As I said, there will be a meeting on 23 October. The European Union wants to facilitate dialogue to prevent further violence. There has to be genuine dialogue between Baku and the Armenian population of Nagorno-Karabakh. We will work with our EU colleagues on trying to facilitate a lasting reconciliation process here.

An Ceann Comhairle

I noticed that Deputy Costello made an oblique reference to the welcome the Azerbaijani delegation received here last week. I want to bring to the Deputy's attention that the Azerbaijani delegation and the Armenian delegation were both in Dublin to attend the conference of European Parliament Speakers and Presidents, which 430 delegates from all around Europe attended. I had the opportunity to meet with both the Azerbaijani and Armenian speakers. In my engagement with them, I pointed out Ireland's total long-term commitment to peaceful negotiated settlements to international disputes. Insofar as their being welcomed in the Chamber is concerned, the Azerbaijani delegation asked if they could come to the Chamber and given that normal diplomatic relations with that country are still in place, it was normal common courtesy that they would be allowed to attend.

It was further normal common courtesy that they would be welcomed. I just wish to set the record straight on that matter.

Housing Schemes

An Ceann Comhairle

We move now to our second Topical Issue matter query from Deputies McAuliffe and O'Dowd, who are anxious to discuss the need for additional funding for housing adaptation grants to enable local authorities to clear waiting lists, and so say all of us for all of the country. I think the Minister of State, Deputy Noonan, is here to deal with the matter.

Minister of State at the Department of Housing, Local Government and Heritage (Deputy Malcolm Noonan)

Yes, I am indeed.

Deputy Paul McAuliffe

As the Ceann Comhairle has said, the housing adaptation grants are a well-understood tool that many of us in our constituency offices or during our time in local authorities would have used to support people to stay in their homes and avoid adding to the requirement for more permanent residential supports. It is one of the more successful schemes that local authorities operate, in that it supports people to live independently.

ALONE and other agencies, however, have highlighted that several local authorities could not meet the needs of all their applicants in previous years. Many of them have significant waiting lists and budget overspends. In my area, for example, and Deputy O'Dowd will speak about his, Dublin City Council, DCC, has 203 applications on its waiting list, while Fingal County Council has 194 on its. These local authorities have already spent 99% of their annual budgets. Turning to South Dublin County Council, it has 95 applications on its waiting list and it has spent 70% of its budget. Nationwide, local authorities do not always keep waiting lists, but several have hundreds of people on unapproved application waiting lists. Many have closed their processes, including in counties Louth, Meath and Monaghan.

This is a scheme that works well. We understand that increased costs have occurred. The Department has a huge capital budget, and rightly so for Housing for All. A portion of this needs to be applied to local authorities to support them to ensure more people can avail of the scheme and that any delay is not because of financial reasons but because of the time needed to process the applications.

Deputy Fergus O'Dowd

The applicants fall into three different categories. The first is priority one, where the applicant is terminally ill, needs a full-time family carer or where adaptation of facilities will allow discharge from hospital. Most of the applications I deal with are priority two, where people are mobile but need assistance in accessing washing and toilet facilities and bedrooms, and where, without the adaptations, the disabled person's ability to function independently is hindered absolutely and unacceptably. It is not, therefore, a good system because it is not working well. There are 3,500 known applicants waiting for the county council to give them the money to go ahead.

Part of the problem is that the county councils have to provide 20% of the funding themselves. I think the Minister of State has a report on his desk which was promised by the end of 2022. I got a reply in June that it would be published imminently, but it remains hidden like the third secret of Fatima. What the hell is going on in the Minister of State's Department? Why is the money not being spent? There is a golden opportunity now to address an appalling wrong. Looking at the television recently, I saw a middle-aged or elderly man going upstairs with a disability who was barely able to move. He was breathless and harassed by the lack of accommodation for him downstairs. We need to replicate that situation some 3,500 times.

In my county, there are 562 applicants on a waiting list. This is a shocking figure, but, wait for it, Louth County Council, in its wisdom, decided some months ago that anybody else who applies can take their applications back and apply again on 1 January 2024. I have met many of these people and this situation is entirely and absolutely unacceptable. The Minister of State's report should identify how the system must change. It must insist on equality of treatment, regardless of where anyone lives or what county they may be in, and whether they are on the waiting list. If people fall into priorities one, two and three, then they should get their grants, and this should be the beginning and the end of it.

An Ceann Comhairle

I thank the Deputy.

Deputy Fergus O'Dowd

We have an opportunity in this budget to put this right and I hope the Minister of State does.

An Ceann Comhairle

Can the Minister of State reveal the secret of the report?

Deputy Malcolm Noonan

I am not sure if I can, but I will try to-----

Deputy Fergus O'Dowd

Well, where is it?

Deputy Malcolm Noonan

The Department of Housing, Local Government and Heritage provides funding to local authorities under the housing adaptation grants for the older people and people with a disability schemes to assist people in private houses to make their accommodation more suitable for their needs. These grants are available to people with an enduring physical, sensory, mental health or intellectual disability, and to older people who experience mobility issues or require essential repairs to their houses so they can continue to live independently at home. The detailed administration of the scheme, including assessment, approval, prioritisation and apportionment, is the responsibility of the local authorities. In 2022, almost €86 million in funding was made available to facilitate the payment of over 12,000 grants, which compares favourably to the target of over 10,700 grants.

The Department works closely with the local authorities to monitor spending and to achieve a full drawdown of available funding. This means that any underspends that arise on the part of any local authority can be redistributed to other authorities which have high levels of grant activity and the Department makes every effort to redistribute such funding throughout the year. The Department encourages all local authorities to ensure all applications on hand are processed to the degree possible for final payment to ensure optimal spend on their annual allocation. Throughout 2023, the Department has continued to approve additional funding to local authorities, with ten local authorities, including Louth County Council, receiving approval for additional funding so far in 2023, with further requests currently under review.

In 2022, Louth County Council received an allocation of almost €2.25 million and spent just over €1.35 million. During 2023, Louth County Council received approval for a further allocation of over €570,000 in Exchequer funding, bringing its total Exchequer funding to over €2.4 million. On foot of this additional funding, the Department has been informed by Louth County Council that it is preparing to reopen its schemes by mid-October, which is very welcome. I am sure the Deputy will welcome this news.

Housing for All commits to undertaking a review, as has been stated, of the range of housing grants available to assist with meeting specific housing needs for our ageing population and people with a disability. The report on the review of the housing adaptation grants for older people and people with a disability has been prepared by the Department. Among the areas which the review considered are the income thresholds and the grant limits. I think this report is due to be published very shortly.

This Department is engaging with the Department of Public Expenditure, National Development Plan Delivery, and Reform on the recommendations in the review report. The objective of this engagement is to deliver on the emerging recommendations and ensure continued enhancement of this successful and important grant scheme. Any changes to the current scheme will be dependent on that engagement and on further funding being made available to the Department through the ongoing Estimates process, which has not concluded yet.

Deputy McAuliffe raised the number of applicants, including 203 in DCC, 194 in Fingal County and 95 in South Dublin County Council. There are significantly high numbers. Even in my local authority, demand always outstrips the grant funding available, recognising the 20% that must be made available through local authorities. This scheme is very important, however, and our Department, and the Minister, Deputy Darragh O'Brien, are determined to get this right and ensure it meets the changing circumstances, including the rising costs of materials and labour in particular. I think the report and, hopefully, some of the ongoing discussions with the Department of Public Expenditure, National Development Plan Delivery, and Reform will bring about a more positive realignment of these grant schemes.

Deputy Fergus O'Dowd

This is not a successful scheme in Westport, where there is a lady who, according to the ALONE survey, is confined to the top floor of her house while awaiting a grant. It is not a successful scheme in Galway, where older people are waiting for money approved in 2022. A woman who is a high-priority case is housebound because she cannot leave her third-floor apartment without works first being completed to facilitate this. She has been waiting since 2022, and lives in social housing. ALONE staff have described the situation as "barbaric". Similar cases have been highlighted elsewhere by staff, including in Dublin.

I do not doubt the integrity or intentions of the Minister of State, but I found the last part of his response did not really give me the facts because it referred to the "emerging recommendations". I think we need to publish them. We need to have representatives of ALONE and other groups and people who care about older people and those with disabilities discuss these issues and have a factual, truthful analysis. We need to get the money for all these families and all these people, and get it now.

Deputy Paul McAuliffe

I agree with Deputy O'Dowd. I think of Willie Bermingham, the founder of ALONE, who established that charity to transform the lives of people who were forgotten. For every person who receives these grants, their life is transformed. However, this also means that for every person who does not receive a grant, their life is limited. We must ensure the financial steps are in place to address that. I have no doubt the review deals with some of the other obstacles people face. Increasingly, it is difficult to hire tradespeople. People are vulnerable in seeking quotes from different people, in not being able to secure quotes and in trying to secure an occupational therapy report and additional reports. There is far more we can do with this scheme. The Department could help to put together panels and have staff available to carry out occupational therapy reports. There is much more that can be done. We should not forget that this scheme saves the State money by ensuring people do not have to go into residential care. I have no doubt the Minister of State wants to see the recommendations of the report published. I want to make sure the Ministers, Deputies Michael McGrath and Donohoe, put money in the budget to get something done on this issue.

Deputy Malcolm Noonan

I reiterate that demand for the grants has been consistently high, which is testament to their success since first being introduced in 2007. With 136,000 grants given up to the end of 2022, a lot of people are being helped. There is no doubt there are significant challenges, as Deputy McAuliffe said, brought about largely by increased demand, with an ageing population, and the additional costs being placed on labour and materials. The Minister, Deputy Darragh O'Brien, is committed to ensuring the review will bring about changes that are necessary to these important grant schemes, and to the ongoing discussions with the Department of Public Expenditure, National Development Plan Delivery and Reform around the funding element. The numbers Deputy McAuliffe provided are very high. It is critically important that there is sufficient support for the local authorities to deliver them. He made some good suggestions and it might be useful to take them forward to the joint housing committee, of which he is a member, for a broader discussion. It is a busy committee but it might be worthwhile to have a deeper dive into the issues and to tweak these hugely important schemes to ensure we get them right and they are fit for purpose to meet the demands of the very vulnerable people who need them the most.

Hospital Facilities

Deputy Maurice Quinlivan

I stood in this Chamber six years ago, in May 2017, with a different Minister of State sitting opposite, when we in the mid-west region were looking forward to the imminent opening of the new emergency department in University Hospital Limerick, UHL. None of us was naive enough to believe it would solve all the problems in the hospital, or even in the emergency department, but we were led to believe there would be a major change. The Irish Nurses and Midwives Organisation, INMO, expressed concerns at the time that up to 24 people would be left lingering on trolleys every single day at UHL. The Minister of State who sat that day in exactly the same seat in which the Minister of State, Deputy Noonan, is sitting tonight rubbished what I and the INMO were saying. The union was saying 24 people would be on trolleys at UHL. Moving forward to 2023, there have, on average, been 100 people on trolleys every day for the past month.

We have had the worst year ever and we are going to have the worst month ever. We will probably end up with 20,000-plus people on trolleys at UHL. These are people who have been assessed as being in need of a bed but there is no bed available for them. I was in the hospital recently visiting people and it is absolutely chaotic. I saw trolleys smashing into each other and trolleys on hallways, in storerooms and everywhere else. Staff are working as best they can in these absolutely overcrowded conditions. It is so bad at the moment that one will see medical devices, bandages and other equipment all over the hospital, in wards and corridors. It is no exaggeration to say that every month in the years since the Minister, Deputy Stephen Donnelly, took office, the numbers have worsened. Given the crisis and the impact on citizens, it would have been helpful if the Minister had come to the Chamber to hear at first hand what is going in at UHL. However, he has done the same as the previous Minister for Health, Deputy Harris, who also ducked the issue and did not come to the House. I have been raising this matter on the Topical Issue Debate since 2016. In my maiden speech in the Dáil, I spoke about the situation at UHL. I have raised it under Questions on Policy or Legislation and every other way in which I could raise it. Yet, here we are with no concrete answers and no solutions.

People are really frustrated and at their wit's end. There is a sense that nothing will be done. The hospital staff are doing an absolutely amazing job. It is clear from HIQA reports and internal hospital reports that there simply are not enough staff. The Minister of State is well aware that if people are waiting on trolleys for a certain number of hours, some will die. That is probably happening every day in our hospitals. It is an indictment of the Government. There is no sense from the people I speak to in Limerick and the mid-west region that their concerns are being taken on board and the issue is being treated with the severity and urgency that is needed. We talk about long-term plans but there is nothing in the here and now.

We have just come out of a summer in which we had the worst figures for the number of people on trolleys in June, July, August and September, and we are now facing into what probably will be the worst three months, which means we will probably tip over the 20,000 figure. That is an absolute scandal and everybody in government should be ashamed of themselves. They have not grasped the issue with the severity and urgency that are needed. I am interested to hear the Minister of State's response. In fairness to him, it is not his fault and it is not his Department, but he probably will read out the same statement I have been listening to for the past five, six or seven years. It is deeply frustrating, not just for me but for the people who are lingering in the hospital and for their family members who are distressed. I am sure this issue is raised with every Deputy in the mid-west region. I am contacted every day by people who are at their wit's end because there are just too many patients presenting to our hospital. This all goes back to the reconfiguration of the three hospitals in 2009, which was a catastrophic mistake.

An Ceann Comhairle

I wish to clarify something before the Minister of State responds. When a Member tables a Topical Issue, the protocol or procedure is that the Department to which it is addressed makes contact with the Deputy and indicates whether a Minister or Minister of State from that Department-----

Deputy Maurice Quinlivan

In this case, in fairness to the Department, I was alerted that the Minister of State, Deputy Noonan, would be here. I raised this issue with the Ceann Comhairle after the previous occasion on which there was no Minister or Minister of State from the Department of Health present.

An Ceann Comhairle

Did Deputy Quinlivan agree that the Minister of State, Deputy Noonan, would take this matter?

Deputy Maurice Quinlivan

Did I have any choice in it?

An Ceann Comhairle

The Deputy could have said he was not going to proceed with the matter today because he would prefer to have the Minister for Health or a Minister of State from that Department respond.

Deputy Maurice Quinlivan

The last time I did that, I was told it would not be facilitated and I could take it or leave it. It was not the Minister of State, Deputy Noonan, taking the matter in that instance.

An Ceann Comhairle

Departments are not the arbiters of whether Deputies must take or leave it.

Deputy Maurice Quinlivan

I hope I will get to raise the issue again and there will be somebody from the Department to respond.

An Ceann Comhairle

The Deputy should talk to my office about that.

Deputy Maurice Quinlivan

I thank the Ceann Comhairle.

An Ceann Comhairle

The Minister of State, Deputy Noonan, is very welcome and we are glad he is here to deal with this matter.

Deputy Malcolm Noonan

Generally, a Minister or Minister of State is on Front Bench cover on a given day and will take a range of questions, whether Commencement matters or Topical Issues, during that day. I am glad Deputy Quinlivan was contacted and informed the matter would not be taken by the Minister for Health or one of the Ministers of State from that Department. This issue of who responds to questions has been raised before. It is important that there be clarity for Deputies who bring forward issues, all of which are serious and important. I respect that Deputy Quinlivan has been raising this particular issue in the Dáil for some time.

I welcome the opportunity to address the House on this issue. The Minister for Health has been concerned for some time about the congestion experienced in the emergency department, ED, at UHL, leading to long patient experience times and patients waiting on trolleys for admission. There were just under 80,000 attendances at the ED in Limerick in 2022, which is up 12% compared with 2019 and is 13% higher than the average for 2017 to 2021. There continues to be a high level of ED presentations in 2023, with more than 59,000 attendances between January and September of this year. I have supplementary information to hand that the Deputy may not have. I can provide it to him after the debate. The figure of 59,000 represents an 11% increase on the same period in 2019. More important is that the attendance figures for patients aged 75 or over have increased by 30% compared with 2019.

There continues to be substantial investment in capacity in University Hospital Limerick, including a 42% growth in workforce since the end of 2019, the opening of an additional 98 acute inpatient beds and a 19% increase in budget in 2022 compared with 2019.

The medical assessment unit, MAU, pathway for 112-999 patients in Ennis and Nenagh hospitals was extended to St. John’s Hospital on 4 August 2023. This initiative allows for patients meeting the clinical criteria to be treated at the MAUs in St. John's, Ennis and Nenagh hospitals. The extension of the 112-999 MAU pathway to St. John’s Hospital means that all three of the UL Hospitals Group MAUs can now treat patients referred by GPs, ShannonDoc and National Ambulance Service, NAS, paramedics. A key element is the telephone referral from the treating paramedic to the receiving MAU doctor, which ensures that the right patient is brought to the MAU. This pathway facilitates patients receiving medical treatment in a hospital closer to their home, assists in reducing patient presentations to emergency departments, and helps to release ambulances more quickly to respond to other emergency calls.

As part of last year’s national winter plan, there was a bespoke, site-level plan for Limerick. While the winter plan officially ended at the end of last winter, many of the plan initiatives continue to be implemented. The local plan focused on local needs and it builds on integration between the community and acute hospital services. UHL’s plan includes measures such as: the recruitment of extra staff including, but not limited to: two whole-time equivalent emergency medicine consultants, additional emergency department registrars and discharge co-ordinators to target patient flow; improving access to diagnostics for both urgent and emergency attendances in the emergency department, and for GPs, and the enhancement of GP out-of-hours supports; and the recruitment of administration staff and the creation of the performance management office to drive the ongoing service improvements in UL Hospitals Group.

The Minister for Health, Deputy Donnelly, asked the HSE to develop a new approach to urgent and emergency care, UEC, planning to reflect the year round demands on emergency departments, including UHL. The approach to planning urgent and emergency care is twofold, which is the delivery of an operational plan for UEC for 2023, recently approved by the Government, and the delivery of a three-year multi-annual UEC plan, which is expected to be submitted to the Government this autumn. The Department of Health is working with the HSE to ensure that the UEC operational plan initiatives are fully implemented.

Deputy Maurice Quinlivan

I thank the Minister of State. With the greatest respect to him, as I said earlier, I am deeply disappointed the Minister for Health or a Minister of State from the Department of Health are not here. It is really important and I do not believe the Minister has grasped the severity of the situation in Limerick, which is ongoing. We are facing a crisis. I have been in the hospital recently. The trolleys are smashing off each other because there is no way to get around. The porters there have told me that people who have a need to be resuscitated and are on a hospital trolley in UHL cannot be moved. If the porters are not able to move them people will actually die. They cannot be moved because there are too many people there. The porters are human, and they know these people. Sometimes it is their neighbours or friends, and often it can be family members.

We need some sort of an intervention from the Minister. The people from the mid-west region have not really heard from the Minister on this issue as much as he should be doing. Everybody understands that the capacity issue is a problem. Everybody everybody understands this happens if one merges three hospitals together. We were supposed to end up with a centre of excellence. In 2009, however, we never got the resources or the staffing that we were supposed to get. We are now dealing with the legacy of this. It is all catch-up.

There is stuff we can do in the moment. Some of the Minister of State's colleagues spoke previously about housing adaptation grants. I would bet my house there are people in UHL tonight who cannot leave because a housing adaptation grant has not been approved for them. It is simple stuff. The Minister said he would do whatever he could do, but that proves he will not. There are nursing home problems, there are issues with home care package that are approved but nobody can do them because the Minster will not pay or retain the staff properly.

Nurses, and especially the foreign nurses who come here, are doing a fantastic job. Some of them stay for five years but they are also actively targeted to go back to Australia or different places. Sometimes they are being offered a free car or offered free accommodation. We need to do something to make sure the staff actually stay. It is also well known that we are short 64 non-consultant doctors in UHL. There is no urgency around doing that.

Deputy Malcolm Noonan

The Deputy made an important point with the connection between home care packages and that a significant proportion of the patients are over the age of 75. The Deputy is correct that we are talking about people's lives and that these are real and significant challenges.

I will give a supplementary response on the emergency department performance at UHL. I will provide a copy to the Deputy when I conclude. The Government is committed to addressing the issues at UHL. Significant resources have been invested in UHL in recent years. This has led to an increase in UHL's workforce of 34% - or 963 whole-time equivalents - since the end of 2019. The Minister for Health recently opened new theatres, wards and clinical areas at Croom Orthopaedic Hospital, which includes the development of an ambulatory trauma service that facilitates transfer of trauma patients from UHL for surgery and recovery, improving patient flow and emergency department congestion.

Part of the solution for UHL is additional beds, and 98 new inpatient beds have opened in UHL since the start of 2020. Work on the new 96 single-bed patient block commenced in September 2022. Construction is expected to take two years to complete. Pending planning approval, the next step is the development of the second 96-bed block, and this will continue. The Department regularly seeks assurance regarding the appropriate escalation of measures for emergency department overcrowding.

Reform of service delivery as outlined in Sláintecare is vital to deal with the increased demand. This includes the expansion of community care and other measures providing people with the care they need outside of the emergency department, improving patient flow and discharge from hospital with more support packages and nursing home supports. Increased funding is being provided for additional GP access to diagnostics in primary care allowing for patients to be referred directly for X-rays or scans in the mid-west. More than 1,400 of these scans are being completed each month.

The matter of emergency department performance is under constant review by the Department of Health through ongoing engagement with the HSE. I assure the Deputy that the Government and the Minister are committed to improving emergency department performance.

Business Supports

Deputy Marc MacSharry

I thank the Minister of State, Deputy Richmond, for his time this evening. We have seen the rapid escalation in the cost of living over the last number of years, much of it driven by inflation and coming off a low-cost basis. We have also had a lot of policy-driven increase of costs. As the Minister of State finalises, with his colleagues, the budgetary measures over the course of the next six days, I appeal to him to maximise the supports to hard-pressed families who have had to sustain huge costs increases in energy, among other costs they have had to sustain over the past year. Last year's supports were very welcome. I very much hope that we could do at least the same this year.

I note that the Low Pay Commission has asked for a 12% increase in the minimum wage, building towards a living wage in 2026 of €14.80. That constitutes a 12% increase on employers. While there is not an employer in the country or a person that would not acknowledge that this is very badly need we must be cognisant of getting the balance right in supports for business. This is a sector predominantly with low margins and highly labour intensive industries who, if they are in food or hospitality or are supermarkets or food manufacturers, are hugely dependent on things like and refrigeration and manufacturing costs with those huge energy increases. The increases in wages over the past years have, of course, put pressure on them but we have also had statutory sick pay, the auto-enrolment for pensions, and the enhanced protective leave entitlements that will come. In certain sectors there were other operational and capital expenditure pressures. In the retail sector now, for example, there is the deposit return scheme. For most businesses this will require a capital of investment between €15,000 and €50,000 and additional staff costs to operate and cater for that. It is a good environmental measure that all industry and all businesses support but we must begin to offset some of these costs against, for example, employment PRSI rates. We must look again to the energy scheme, the temporary credit and business energy support scheme, that we did last year. It came to an end in July and claims will have to be in by the end of September. I would like to see that scheme being extended and the eligibility revised to admit additional people, particularly those in the highly energy-intensive areas, such as retail, hospitality, food manufacturing and so on.

As I say, while seeking maximum supports for families and acknowledging we need to transition towards a national living wage, with increases in January of up to 12% being spoken of, on this occasion and for the next three years, I believe when it comes to the business sector that the Government needs to offset this increase against other measures which businesses can embrace.

The difficulty is we are talking about small independent retailers, restaurants, bars, hospitality generally and manufacturing which employ approximately 1.2 million people, as the Minister of State will be aware, with up to 250 employees per company and some companies employing as few as nine. They employ huge numbers of people in total, contributing to every household in the country. While we want to do all we can to offset the costs of families, we must ensure also that we are protecting employment and the cost of doing business through introducing the appropriate measures for them.

Minister of State at the Department of Enterprise, Trade and Employment (Deputy Neale Richmond)

I greatly welcome this opportunity to respond to a salient and timely Topical Issue from Deputy MacSharry. I am grateful to the Deputy for giving me this opportunity to lay out a few things on my mind and, indeed, on the Government's mind as we approach the budget next Tuesday.

As the Deputy will be aware, I tour the country every week visiting businesses in every county, and these are the concerns that are raised in businesses of all sizes. It can be the retail sector, which is the largest private sector employer in the State or the owner of an SME, which employ in excess of 75% of people in the State.

The costs are mounting. I do not need to list the measures that the Government is introducing regarding increasing the minimum wage, moving towards a living wage and much else. These are well signalled and we will not be changing these plans.

The Low Pay Commission report has been received by Government. I am awaiting that decision to be made by the Cabinet not only regarding the recommendations for a minimum wage but also regarding the sub-minimum rates of the minimum wage, which I believe have been flagged in Private Members' business by the Cathaoirleach Gníomhach, Deputy Quinlivan's party as well as the Labour Party. Throughout this, the Government is well aware these much-needed changes to employment law and the employment area in the State come at a serious cost, not for the Government per se but for the businesses that have to implement them. We acknowledge that the costs for businesses more generally have gone up exponentially over the past couple of years, and not only due to inflation, be it rising food inflation, which thankfully is starting to come down, or rising energy costs, which have been coming down.

The Deputy referred saliently to the temporary business energy support scheme, TBESS, in terms of the supports given to businesses over the past year. More than 30,000 businesses have applied for this scheme. Businesses with ten to 50 employees were the most common group to avail of this. In Sligo alone, the Deputy will be aware that 767 claims were received and processed for the TBESS scheme in the past calendar year, with more than €2 million paid to businesses in the county. This scheme has been expanded in recent months.

The new development of the business users support scheme is for those businesses, not necessarily in my constituency but probably more widely, which use kerosene, with a minimum payment of €500 towards their increased kerosene costs. This follows on from temporary reductions in VAT on electricity and gas and much else, as well as the general significant supports that are available through Enterprise Ireland or local enterprise offices. I do not need to go through the individual counties' returns.

The Deputy mentioned the deposit return scheme that is due to come on board. This is something that was raised by Mr. Finbarr Filan, a retailer in the Deputy's own county. The Deputy knows him well. A good guy, a stand-up guy and a pillar of his community, Mr. Filan runs an excellent supermarket in Sligo and has raised the fact the smaller retail stores similar to his own and probably a little bit smaller are not able to avail of grant aid. That is certainly a serious ask I am making, that we are able to expand that not just to the large multiples or retailers but to all sides. We need that scheme to work, as the Deputy correctly says, because it is not just an environmental matter. I do not know how many times over the past two decades I have been to conferences and meetings where we have talked about deposit return schemes and following continental examples. We are now making it a reality, but we appreciate the cost of that reality needs to be met by Government as well as by the retailers.

The closing point I will leave the Deputy with is that, in relation to the new rights and the changes to the minimum wage that have happened, are happening and are signposted to happen, one of the main things the Government is undertaking through my own Department and the Department of Social Protection, which is my other Department, is a serious review of how those costs are impacting businesses and what can be done. We hope to have that report published in December, and what will then follow is where the Government needs to step up to meet the needs of businesses to make sure these changes can be implemented properly, because they will be implemented.

Deputy Marc MacSharry

I thank the Minister of State. There is not an employment organisation in the country that does not agree with transitioning to a minimum wage, that does not agree with the economic measures that have been done for families - more are needed - and that does not agree with the additional issues around statutory sick pay and whatever, but it is to balance that against their rising costs in an appropriate way. As I said, employers' PRSI is one way. Other tax credit schemes are another way. A further extension to the temporary business energy support scheme and a re-look at the qualifying criteria would be hugely beneficial.

The deposit return scheme is fantastic, but we must acknowledge the capital outlay, in particular, of the larger stores. Some of the smaller stores have exemptions, etc. One retailer, for example, employs approximately 85 employees. These food-intensive supermarkets and independent retailers have huge electricity costs because of the need for refrigeration, freezers, etc. From 2019 to 2023, its wage inflation was 44% and the cost of electricity increased by between 72% and 100%. We must find ways to offset some of this. IBEC, Chambers Ireland, RGDATA or the other retail and trade associations such as the Restaurants Association of Ireland, the vintners, etc., all acknowledge that these are vital improvements for workers. They only want help in offsetting those costs so that they do not have to bear the brunt of them entirely on their own. At times in the past, when things were perhaps better for people, employers were in a position to step up that little bit more. Unfortunately, at the moment they are put to the pin of their collar. While I hope we maximise our outlay for families next week, let us also not wait for the Minister of State's December report. Let us take the appropriate steps at a minimum with a temporary credit against employers' PRSI and an extension and a revamp of the temporary business energy support scheme so that businesses will have some chance.

I appreciate the Minister of State's time and very much hope my words can be reflected in some way in the announcements of next Tuesday, which I hope to be in a position to support.

Deputy Neale Richmond

I fundamentally agree with the Deputy. The Deputy and I know better than most that there are an awful lot of promises made in this House in relation to the support needed for families and individuals in the cost-of-living crisis, but we also know that while we can make all the promises we want, if we do not have a thriving functioning economy, it is all for naught. We need the businesses and the economic powerhouses to produce the tax returns to allow us take the necessary measures that will be announced next week in the budget, be it in social welfare payments or support for that squeezed middle the Deputy defends every day, be it in Sligo, Leitrim, Donegal or the small part of Roscommon he also represents.

On the report, I fundamentally take the Deputy's point. We will not be waiting for the result of the report. That will be supplementary to what will be announced next Tuesday in the budget, affecting both my own Department and all Departments, because this is an all-of-government approach.

I reassure the Deputy that I am in full agreement with his points and the overall thrust. On what can be done and the most important thing the Government can do, we are making massive changes. They are necessary but we acknowledge they come with a cost that is largely borne by the same employers we require to fuel and drive our economy. The most important thing we can do is signpost those changes. There can be no surprises. Every employer in the country knows statutory sick pay is moving from three days to five days on 1 January. I will sign that order on New Year's Day. They also know we are moving towards a living wage and we will achieve that as per the timeline set out. It will not change. We will not deviate, but I fundamentally agree there are a number of measures that can be taken in relation to tax credits, in terms of grant aid through the various State agencies and through low-cost finance, and, crucially, through the budgetary supports there will be for businesses next Tuesday. I will not reveal what those supports are now because they have not been decided and they probably will not be decided until late - until Sunday night. The Deputy has been through more budgets than I have and he knows this is the way these things will be decided.

We simply have to support businesses on this journey. I will commit to the Deputy tonight that his points will be fed into that discussion and we will, crucially, support those businesses.

Cuireadh an Dáil ar athló ar 10.40 p.m. go dtí 9.10 a.m., Dé Céadaoin, an 4 Deireadh Fómhair 2023.

The Dáil adjourned at 10.40 p.m. until 9.10 a.m. on Wednesday, 4 October 2023.