Skip to main content
Normal View

Dáil Éireann debate -
Thursday, 19 Oct 2023

Vol. 1044 No. 3

Ceisteanna ó Cheannairí - Leaders' Questions

I dtús báire, is mian liom mo dhlúthpháirtíocht a chur in iúl do mhuintir Chorcaí agus pobal iarthar Phort Láirge sna ceantair sin inar tharla tubaiste tromchúiseach inné nuair a bhí tuillte ansin. Bhí tionchar mór ag na tuillte ar go leor tithí agus gnóthaí ar fud an cheantair sin agus bhí go leor damáiste déanta. I take the opportunity to extend my solidarity, and that of my party, to the people of Cork and west Waterford who experienced serious flooding yesterday. I commend all of those who were on the front line trying to save businesses, homes, and indeed, people, in their efforts. Many homes and businesses have been impacted and there has been very serious damage. The town of Midleton is the epicentre of this disastrous flooding and locals are describing it as the worst in living memory. Households and businesses are seriously damaged, roads are completely impassable, schools and local services for vulnerable people are badly impacted, and many homes are without power. A boil water notice is also in place and water stations have been set up in the Gaelscoil. It is a very tough time for the communities affected but their community spirit has shone through. Just one example of that is Sarsfields GAA club, which, in an effort to protect its community, made the decision to open its floodgates and have seen its pitch destroyed and clubhouse damaged. I know the Taoiseach is due to arrive in Cork around now and I hope he tells the community there that it will have the full support of the Government in recovering, rebuilding and putting in place the protections against the impacts of future storms.

We are fortunate that no lives were lost, given the fact that elderly citizens in hospitals right through to toddlers in crèches were left in flood waters. Many of the homes and businesses affected have no flood protection insurance so there is an urgent need to ensure emergency funding is provided to the local authorities involved and to the individual families and businesses. I ask the Tánaiste that all emergency funding necessary will be made available without delay. Will he spell out what that will look like and when it will be made available? We know parts of County Cork are prone to flooding. The Tánaiste knows this well. Yet, flood relief works are continually being delayed. In Glanmire, which was once again hit by serious floods yesterday, the people of that area have been crying out for flood protection for over 20 years. The delays of the flood relief scheme, which spent years sitting on the Minister's desk, have come home to roost. These types of delays need to be addressed. That scheme disgracefully took three years to receive ministerial consent and because of those delays, work has only just now started. It is not good enough and many residents will justifiably be feeling angered about that this morning.

I am sure the Tánaiste agrees that we also need engagement between the Government, Met Éireann and local authorities to develop a more localised warning system. That would be a very positive step. Does the Tánaiste accept there could have been more of a concerted effort to ensure that families and businesses were sufficiently warned of yesterday's flooding? What will the Tánaiste do to ensure other flood protection schemes will be expedited so that the risk can be minimised in those parts of Cork most prone to flooding? Crucially, as families, businesses and communities wake up to the devastation of the floods that took place and which gripped their communities yesterday, those people who have seen their homes and businesses devastated by the flooding want to know they will not be made to jump through hoops and go through all of this red tape to access emergency funding. When will they get the vital support? Will the Tánaiste spell out to people who do not have flood insurance because these communities were hit before by floods, what will happen, what support will be provided by Government and when will it meet them on the ground?

Níl aon amhras ach go bhfuil brú faoi leith ar mhuintir na tíre go háirithe i gCorcaigh agus i bPort Láirge de bharr an méid báistí a thit inné. Bhí sé uafásach ar fad agus tá daoine ag fulaingt dá dheasca sin. Táimid ag déanamh gach aon iarracht chun cabhair agus tacaíocht a thabhairt do mhuintir na dúiche, i Mainistir na Corann ach go háirithe, agus i nGleann Maghair agus i lár chathair Chorcaí. I thank the Deputy for raising this very important issue. Our immediate thoughts are with the households and businesses affected by the fierce flooding yesterday, particularly in County Cork, Cork city and west Waterford. It has been very distressing for many people. We are deeply concerned about what has transpired and I thank all the volunteers, the Civil Defence, the local authorities and the Defence Forces personnel who were deployed from mid-afternoon yesterday to the locations and particularly to Midleton, for the work they did. I also thank Sarsfields GAA club, which incidentally won the county final last Sunday against Midleton, for opening up its pitch to save a housing estate from flooding. We will make sure we work with the club to help it in any way possible because that is the kind of intervention that makes a huge difference to a community. It was quick decision-making and we applaud that action. Sarsfields is the club of the late Teddy McCarthy and has an outstanding tradition of serving its community.

The humanitarian assistance scheme is available to provide support to those living in properties directly affected by the flooding. A fund of €10 million is already in place for this scheme. It prevents hardship by providing support to people whose homes are damaged by severe weather. We will work with the local community on this and the Department of Social Protection is liaising on the ground with the people affected to make sure they have access to the help they need. If any homeowner affected by Storm Babet needs to access these supports, they can contact community welfare service by phone. We will outline the numbers and so forth. The Department of Enterprise, Trade and Employment has an emergency humanitarian flooding scheme, administered by the Irish Red Cross, which is available to small businesses with up to 20 employees, for community, voluntary and sporting bodies. The Taoiseach is going down today and the Minister for Finance is also visiting, as is the Minister of State, Deputy O'Donovan, with special responsibility for the Office of Public Works, OPW. We will examine the situation, assess it, and the Government will meet next week to see what additional work it can do to support the community.

The Deputy referenced the flood relief schemes. To be fair, the Government is in office three years. Deputy Pádraig O'Sullivan prioritised the flood relief scheme for Glanmire and worked with the then Minister for Public Expenditure and Reform, Deputy McGrath, at the time to get it onto the agenda. There are many flood schemes out there. Construction began in July this year. There is a lot of design stuff and so forth. That flood relief scheme is to protect approximately 103 properties from flooding from the Glashaboy river and will take 32 months to complete. The OPW is also working on a scheme in Blackpool to protect 293 properties. The total project budget is some €21 million. Again, that was approved in March 2021 and the decision was challenged by Save Our Bride Otters, an organisation which wanted to protect the otter population there, and that has resulted in further information being requested from the OPW in support of requests for consent under the Act. The city's flood relief scheme has been delayed for a considerable length of time by civil society groups which have different views, notwithstanding all of the submissions and so on.

We are way over time.

There is an issue but continuing objections that lack balance and perspective in the process are delaying many flood relief schemes across the country and that needs to be faced up to, not just by Government but by the entire House. We need balance and perspective in all of these matters.

So in Midleton.

I made the point that the Glanmire flood relief scheme was announced in 2016. The floods happened in 2012 and it took three years for ministerial consent. Nobody in the community is opposing it or objecting to it. They desperately need it and they were hit again yesterday with devastating floods. The Tánaiste spoke about humanitarian assistance funding. It is means-tested. Will the Tánaiste outline that people in the community who have means above the €30,000 threshold will not be getting 100% support for the damage again caused to their homes? Will there be a look at this threshold? These communities have been left at the mercy of the elements because the schemes have not been put in place. Places where schemes have been put in place are being protected. We know it works. Will the Tánaiste address this issue? With regard to businesses, will the Tánaiste outline when additional supports will be made available to them? The Tánaiste mentioned Sarsfields GAA club. Donegal has had experience of this where we have had floods.

The time is up.

I will finish on this point. Many community facilities took years to be replaced. Sarsfields summed it up in one quote, "'We won a county, lost a pitch but hopefully saved a part of the Glanmire community."

Thank you Deputy.

Now it is time for the Government to step up and support not only Sarsfields GAA but also other facilities, including our hospitals, crèches, businesses and households-----

The Deputy is way over time.

-----very quickly without delay. Crucially we need to speed forward the types of schemes that will protect communities in the medium to long term.

Will Members please adhere to the allotted time?

There is no doubt that businesses have been severely affected, in Midleton in particular. Deputy James O'Connor was at the scene very quickly yesterday evening. He related to me how severe it was on businesses and households. As I said earlier in my reply, we are examining what level of intervention we can make in respect of supporting the households and businesses that have been undoubtedly affected.

We have always been strong supporters of Sars down through the years through various sports capital grants. Given its intervention on this occasion we will not be found wanting. The wider community through Civil Defence and Defence Forces personnel are still there. We applaud what they are doing. There are also all those volunteers from businesses whose employees came out in Midleton and elsewhere to help. It was very severe. It is estimated that one month's rain fell in a couple of hours. I repeat that we need an honest debate on the flood relief schemes. Approximately 95 are either at design stage, under construction or in planning.

Thank you, Tánaiste.

A total of 53 have been completed. Where they have been completed they are working to prevent damage. We have to bear this in mind and have an honest debate about it

I will begin by expressing my solidarity with the people of Cork and west Waterford who have been impacted so severely by the flooding yesterday. I will return to this later. I want to raise the issue of healthcare spending. Last Tuesday the Government presented a "Once upon a time, in a land far, far away" sort of budget that was full of gaps with dodgy estimates. It has been exposed in many ways as a work of fiction. Nowhere is this clearer than in the health spend. The Government announced a health budget with a €2 billion hole in it. Bernard Gloster, the CEO of the HSE, has said the moneys allocated to the health service in the budget are inadequate and the funding is not sufficient to meet the expected demand for health services. This is very serious.

The front page of today's edition of the Irish Independent reveals that Government Deputies are apparently less worried about the substance of Mr. Gloster's concerns than they are about the very fact he stated them at all. These concerns are very real. It is extremely serious that the Minister for Health has announced a recruitment freeze during an acknowledged staffing crisis. This is a hammer blow to all those who work in the HSE who tell us how under-resourced they are. It is a hammer blow to Bernard Gloster who says that patients will be harmed without the recruitment of additional staff. Most of all, it is a hammer blow to the people of Ireland and those who are now wondering whether they will have access to health services if and when they need them.

The freeze on recruitment is outrageous. Having begged doctors, nurses and healthcare workers not to leave us for Australia and other places, the Government has effectively turned around and said never mind that. This week HIQA reported that staffing in hospitals such as St. James's Hospital and Mercy University Hospital is at a critically low level. The Irish Nurses and Midwives Organisation, INMO, is warning us that the recruitment freeze will send the healthcare system into freefall. Adding insult to injury were the comments of the Taoiseach in the Dáil on Tuesday, when he played down what he termed "talk" of a recruitment and retention crisis, one that we all hear about all the time in our constituencies.

The Tánaiste's Government's refusal to return to the rest of us here on Earth is evident throughout the budget on health. More than 4,000 patients may be unable to access potentially life-saving treatments next year due to the decision not to provide dedicated funding for new drugs. We know that more than 6,000 people throughout the country are desperate for access to home care due to a lack of carers available. Almost 900,000 people languish on some form of health waiting list, more than 100,000 of whom are children and young people.

Today we heard at the Committee on Public Accounts, under questioning from Deputy Kelly, that the new children's hospital is drifting further and further out of reach with a projected spend now of €2 billion. The blame lies squarely at the feet of the Government. Most galling of all is that we do not know who is responsible for the shortfall in funding. Is it the Minister for Health or the Minister for Public Expenditure, National Development Plan Delivery and Reform? Will the Tánaiste explain whether the Government can ensure safe staffing levels through the winter? What plan is there for the health service to ensure that sick people who present at hospital will not be left on trolleys or sitting on chairs?

It is the entire Government that produces the budget and delivers the budget across the board. In terms of any report, I fully respect the right of the chief executive officer of the HSE to comment on the budget, to brief Deputies - and he would not be the first CEO to brief parliamentary representatives in the House - and to engage with the Government in respect of issues pertaining to the budget. I have no issue with the new CEO engaging with public representatives or doing interviews. He is a very experienced public servant. He has been in public service for 34 years. He was very involved with Tusla and its reform. We look forward to working with him. He is only six months in the job.

The Irish healthcare system has received significant investment in recent years since the Government came into office. The health sector has been prioritised, with increasing budget allocations of more than €7.4 billion since 2019. This excludes funding for disability services. By any yardstick this is a significant increase in funding over a relatively short space of time. In this context, my view is that we need to do a deeper analysis of healthcare expenditure, parallel with analysis of future trends and ageing demographics more specifically. I noticed, leading into the budget, that the amount allocated in some Opposition budgets was very similar to what the Government has allocated. Sinn Féin's budget was the very same.

You are hilarious.

You will get on well so.

You are getting very nervous now when responding. It is the Labour Party that has an opportunity now and I am just making this point.

This analysis needs to happen in my view. I will come to the recruitment issue. Cost management is very important. When I was Taoiseach in 2020 we were presented with information that the 2019 budget would have a €1 billion structural deficit. We dealt with it and we added more. Lo and behold, there will be a substantial deficit again this year. It needs examination given the scale of increase that occurs on an annual basis. This applies to all parties in the House. Some of this is societal demands, such as ageing demographics and inflation. By the way, the expenditure overall in the past two or three decades has worked because our survival rates for cancer, stroke and infant mortality have really improved.

The time is up.

This year's budget will facilitate significant developments. I want to make a point on recruitment.

The time is up.

Many posts that have been funded have not been recruited. A lot of the recruitment issues we have experienced in the past year are not funding related but are human resource issues.

The Tánaiste's replies just do not pass muster. He spoke of a need for analysis and for examination but the reality is that the Tánaiste and Fianna Fáil are in government-----

Since the foundation of the State.

-----and the party has the Minister of Health portfolio.

We need to hear from the Tánaiste what the plans and the figures are that are going to work in the budget. I say this because clearly, the Government's figures in last week's budget simply do not add up. This is acknowledged. Where are the plans to help those struggling people working in the health service who are so under-resourced and overstretched? Where are the plans to help patients? I refer to patients like the woman who contacted me and told me she had developed blood poisoning and was left in a chair overnight, propped up against the wall, due to a lack of beds. All of us are hearing from people who are telling us they were turned away from scheduled appointments because of a lack of staff. This happened after they had booked time off work and fasted for their procedures. This sort of thing does not happen in a properly resourced health service. The Tánaiste is in government and it is simply not good enough to hear him speaking as if he were a commentator and saying there is a need for analysis and examination. He should do something about this situation, ensure the health service is properly resourced-----

I thank the Deputy. The time is up.

-----and ensure that the appropriate Minister, namely, the Minister for Health, is in charge of the budget. What we are hearing makes it unclear to us whether it is the Minister, Deputy Stephen Donnelly, or the Minister for Public Expenditure, National Development Plan Delivery and Reform, Deputy Donohoe, who is calling the shots.

The time is up, please.

Either way, there is not enough money for healthcare and it is the patients and staff who are going to suffer.

Deputy Bacik should talk to her colleague, Deputy Brendan Howlin, who was both a Minister for Health and a Minister for Public Expenditure and Reform. He might fill in Deputy Bacik and give her some insights into how the process works.

That was years ago. It was two governments ago.

What I can say is that-----

That is so patronising.

-----we have cut costs across the board for patients. We have removed inpatient hospital charges.

The Government has cut services.

We have had the biggest expansion of access to free GP care in the history of the State. Up to 60% of our population now hold a GP or medical card.

If there is no problem, then give a card to every child.

There have been record patient-----

We have reduced the drug payment scheme costs.

-----and 1 million people waiting for care.

There are record-----

So, there is nothing to see here and everything is okay.

We have funded diagnostic scans for patients. We have introduced free contraception for women up to the age of 31. We have publicly funded assisted human reproduction, including IVF, for the first time. We have agreed a new contract for consultants and up to 700 have signed up to it. We have added more than 22,000 staff since 2020. Funding has been provided for 22,000 staff since then.

Is the recruitment freeze on the Tánaiste's list?

And child and adolescent mental health services, CAMHS?

We have increased our hospital bed capacity by more than 1,000 beds at the same time, and we have also expanded our ICU capacity.

The Minister of State, Deputy Butler, has said she-----

We are increasing college and training places. For every GP who retires, between one and a half and three new GPs are working. We also expended huge funding in the context of the pandemic.

We are doing the actions.

I thank the Tánaiste. The time is up.

Having said all that, and with there having been €7.5 billion in additional funding since 2020, I am making the point and there is nothing wrong in saying there is a need for further analysis in this regard in terms of our growing population-----

We need further money.

(Interruptions).

Analysis that is logical and informed-----

Old habits die hard.

That is enough now, thank you.

(Interruptions).

-----and not just sort of-----

Could we have a little less heckling, please? I call Deputy Mick Barry.

More rain fell in parts of County Cork in a few hours yesterday than would normally fall in a month. Midleton, Castlemartyr, Glanmire, Killeagh, Cloyne, Whitegate, Blackpool, west Waterford and other places all experienced devastation to one degree or another. In Midleton, patients had to be evacuated from a hospital and children had to be carried out of a childcare centre by parents via piggyback. In Glanmire, Sarsfields GAA club allowed its pitch to flood to protect the wider community. The pitch, the drainage, the offices and the walls were all destroyed. We won a county. We lost a pitch but, hopefully, saved part of the community.

The Taoiseach is due to arrive in Midleton in 20 minutes' time. He will don the raincoat and wellingtons, pose for the cameras and say the right things. Come tonight, he will be gone and the devastation will be left behind. The Government will be judged not by the quality of the photo opportunity but by the quality of the relief operation, the speed and size of the compensation package and, crucially, on the actions taken now on flood defences. Again and again, in town after town and community after community, people are saying that the defences they were promised have not been put in place and the State's response is not keeping up with the climate threat. Spain and Greece have been hit by heatwaves and Canada has been swept by wildfires, but in this country, and in our county, the biggest threat is the rain and the floods.

The OPW organised the catchment flood risk assessment and management, CFRAM, programme in 2018. Some €1.3 billion has been provided for the years from 2021 to 2030, which is €144 million annually. Does the programme need to be redone now, with updated climate models? I think more finance needs to be put aside and greater urgency needs to be shown in actioning the plan.

Great praise is due to the public sector workers who pitched in during this emergency. For the information of the Tánaiste, however, the workers who clean the gullies for Cork City Council have been asking and pleading for years now for simple tools like angle grinders to open up the gullies and for more staff and more vehicles, to little or no avail. The firefighters who intervened in Midleton yesterday should have had swift water rescue technician training, but they do not. They were not trained for such a scenario and were forced to take unnecessary risks. When is the State going to give these workers the backing, support, training and tools they deserve?

The Deputy spoke about flood relief schemes. He may recall his own comments in relation to the Cork city flood relief scheme, where he described the OPW's proposals as crude and not taking into account the people of Cork's relationship with the River Lee. He backed the campaign to, essentially, undermine the OPW's programme of flood relief. I have no problem with people making submissions and trying to adjust and adapt schemes, but when this goes to the extent of delaying schemes for years, then I do have a problem. When the OPW does respond, change and adapt schemes, then I have a real problem.

There is about €1.3 billion in the national development plan, NDP, for flood relief schemes. The flood relief scheme design that has emerged from Glanmire is under construction now. I pay tribute to Deputy Pádraig O'Sullivan, because he drove that initiative prior to getting elected. He made it a campaign issue for himself. Those works are now under construction. To be fair to Deputy Pádraig O'Sullivan, he did work hard to put that project on the agenda with others.

In Cork city, the flood relief scheme has now been going on for years because of objections ending up in court and so on. People must have balance and perspective. Cork has been flooding since I was growing up. The quay walls have not been properly addressed. What is being proposed is excellent in terms of the public realm improvements such work would represent, as well as preventing flooding in the city centre. Yet there are objections. In Blackpool, an area Deputy Barry knows well, again there has been an inability to resolve the problems there and it is going the full distance in terms of objections to the flood relief scheme. If we were to talk to the traders and the people who live in Blackpool, they would tell us they have had numerous floods.

The funding is there and the schemes are designed but it is just taking far too long in terms of the planning process, in my view, with objections and people not looking at these proposals from a balanced perspective. We must weigh things up. We are not going to get the perfect solution. We all have subjective views as to what constitutes the best type of flooding scheme, but we are not all self-appointed experts either. There comes a stage when it is necessary to facilitate the construction of flood relief schemes that would make a huge difference. Where they have been put in, in Clonmel, in Fermoy and in Mallow, they have been effective.

In Douglas, close to where I live, there was a terrible once-in-a-century flood and the scheme there worked yesterday. On the Owenacurra river, a flood scheme is emerging for Midleton. Again, we want to see these developed. The money is there to get these projects done. I do not make these points to try to attack anybody or anything like that, but only to point out some realities and the need for an honest debate about this subject. I think adaptation is the key issue for the country in respect of climate change now. We are dealing with the causes of climate change but it is happening here and now.

I thank the Tánaiste. The time is up.

Getting one month's rain in a day means we have to adapt faster. This means we have to put in the flooding schemes much faster and society has to respond in that spirit.

Yes. If we are to be ahead of the curve here, and we see what is coming in terms of climate change, then in Cork city we need to be looking at options like a flood barrier. There are many experts, and I am referring to people who are qualified to speak on this subject and not lay people, who have said this is the way to go. I strongly urge the OPW and the Government to look at this possibility as an option. In Blackpool, I believe there are alternative ways of dealing with this issue, which would protect the wildlife and the village as well. These should be examined as well.

The final point I wish to make is on the question of insurance. Two days ago, Allianz Insurance announced profits of €50 million, which was an increase of 12%. FBD's pre-tax profits are up to €39 million for the first six months of 2023. We have a fabulously profitable insurance industry that refuses to cover homes and businesses at significant risk of flooding.

Homes and businesses have the right to insurance cover. We need not-for-profit insurance cover in this country. In my view, the industry needs to be taken into public ownership.

We will look at all of those issues in both schemes we have for flood relief, including the humanitarian aid scheme and the scheme for business. With regard to Midleton, there is a total project budget for the flood relief scheme of approximately €50 million. The option has emerged for Midleton to protect 250 properties and that will provide protection in flooding from the Dungourney and Owenacurra rivers. The environmental impact assessment is being prepared for the preferred option. Hopefully, planning will happen in the first part of early 2024. We need that to go through in respect to the project.

The Deputy referenced to a visit. It is important that the Government, that is the Minister for Finance and the Minister of State with responsibility for the Office of Public Works, would go down to see it. We will follow through with supports for businesses and for households, and see what we can do to be of assistance. This is a very severe flooding event. Of that there is no doubt.

The Minister for Health, Deputy Stephen Donnelly, received a letter two weeks ago from almost 80 GPs in County Donegal and a letter last week from consultants in Letterkenny University Hospital in Donegal calling for urgent action in the emergency department at Letterkenny University Hospital. In the letters, GPs and consultants warn of a service collapse and call on the Minister and senior officials to step in and carry out an external review of the emergency department, with an action plan put in place regarding access to the emergency department and acute services.

Letterkenny University Hospital is in crisis. Over the past few weeks, patients have been forced to wait for more than 24 hours and, in many cases, 36 to 48 hours to be seen. There are no seats available for those waiting in the emergency department it is so crowded. There is a serious risk to patients in Donegal arising from deteriorating conditions in the emergency department and a lack of hospital resources. Letterkenny University Hospital is one of the busiest hospitals in the State, yet it gets far less funding per patient than most other hospitals. This is yet another sign of Donegal being ignored and under-resourced. It cannot be ignored and it requires urgent action from the Government.

The Minister has said there is a recruitment issue in Letterkenny. I once again take this opportunity to urge the Government and the HSE to collaborate with Cuba in sending doctors to Ireland to relieve pressure on Ireland's health service. Cuba has in the past provided medical services in 165 countries, with more than 605,698 employees. Cuba currently serves 59 nations, including Portugal, Italy and Sweden within the EU. The services are there and Cuba is willing to do it. All it needs is for the Government to ask. I do not believe that is too much to ask. If there are issues with recruitment, I am not sure why this solution has not been sought. Collaboration with Cuba would significantly improve conditions in Letterkenny University Hospital and the State of the healthcare system in this country overall. I have been raising this issue since June of last year but the Minister has failed to engage with me or with the Cuban ambassador on this issue, despite numerous attempts. The recruitment issue will not rectify itself. It requires thinking outside the box. If he was serious about addressing the situation in Donegal, he needs to consider this as an alternative as well.

Recruitment is only part of the solution. We also need to focus on retention. At least 88 overseas nurses and midwives have taken up roles in Letterkenny University Hospital since the beginning of last year. I will take this opportunity to express my solidarity to the migrant nurses who were outside Leinster House on Tuesday calling for family reunification as many are separated from their spouses and children due to their low pay not meeting visa conditions. They provide a service to the country and they should not be punished for it. They deserve pay parity with HSE workers to bring them above the visa threshold.

What will the Tánaiste do to address recruitment and retention issues in Letterkenny University Hospital to allow the fourth busiest accident and emergency department in the State to respond to the needs of the community once and for all?

I thank the Deputy for the question and I thank all of the staff who help to keep our health services working on a 24-7 basis. They deliver a public service under very challenging circumstances.

The Minister for Health received a letter and I have read the letter. He is very concerned with the issues raised in the correspondence and will meet with representatives of the GPs next week and will discuss the issues they have raised in their letter.

The budget for the hospital has increased from €142 million in 2019 to €177 million, which is a 24.5% increase. This is significant in itself. There are 2,144 whole-time equivalents employed by Letterkenny University Hospital, which is more than a 20% increase since 2020. There has been a lot of capital investment in the hospital. Capital projects completed in past two years include the expansion of gynaecology services, the opening of the acute stroke unit, the provision of an additional endoscopy theatre and a new maternity theatre. An additional 49 acute beds have been delivered since 2019 to the hospital and further capital projects are under way that will add capacity and services for patients. These include expansion of the renal department, expansion of the oncology day unit and the electrical infrastructure upgrade.

There is a lot of pressure on the emergency department. I believe there were 43,000 attendances in 2022, which is a 13% increase on 2019. In 2023, there were 40,000 attendances between January and September, which is a 25% increase in overall numbers over 2019. Most importantly, the attendance figures for patients aged 75 or older is more than 6,200, which is a 1,100% increase compared to 2019. We are witnessing a post-Covid increase in attendance across the health system. It is evident in Letterkenny and it is evident across most European healthcare systems. It also reflects the growing and ageing population.

We have expanded community care and other measures with a view to providing people the care they need outside of the emergency department and improving patient flow and discharge from the hospital with more home support packages and nursing home supports. Increased funding has been provided for additional GP access to diagnostics and primary care allowing for patients to be referred directly for X-rays and scans. In community healthcare organisation, CHO 1, which includes Letterkenny University Hospital, 14,500 of these scans had been completed by early October this year.

The Minister will meet with the staff. I note that the letter relates to access to the emergency department but we need to look not just specifically at the emergency department but the entire continuum from primary care to community care to diagnostics and the wider hospital group. That is a management issue locally and regionally under the Saolta University Health Care Group in how hospitals are organised, how patients are triaged and how patients are referred to various services.

The Tánaiste has outlined some of the positive stuff that happened in Letterkenny over the past couple of years and that is true but in reality all of that happened because the hospital flooded. That is why it happened and that is why this work was carried out. The hospital is greatly increasing the numbers at all times and even with all the work that has been done, we are in this crisis situation.

The letter from GPs states : "We have patients who are refusing to attend the emergency department because they would rather ‘take their chances’ and stay at home." From first-hand experience I know this is actually happening, whereby patients are deciding to stay at home rather than going to get the treatment they need. This is because of the delays and so on. The emergency department is being used as a gatekeeper for the rest of the hospital. This is part of the problem in what has happened.

Letterkenny University Hospital is consistently the fourth or fifth busiest hospital in the State with more than 23,000 patients a year being discharged from the hospital. Since 2020, the number of patients being seen in under six hours by the emergency department has declined from 80% to 52%. While the standard is 80%, only 52% are seen within the time. Patient numbers waiting for more than nine hours have increased from 6% to 27% in the same period. There is a problem. I am glad the Minister is meeting with the GPs. I hope an action plan will come out of that and we will actually see the problem being resolved.

The Minister will meet with the doctors. I take the Deputy's point that emergency departments can become the gatekeepers for the rest of a hospital. That was the point I was making in that it does need a more whole-of-hospital approach. Where that happens, there are very good outcomes in hospitals across the State.

The Deputy referred to Cuban GPs.

They are exported by their government.

I am not sure that is a system that I would like to be co-operating with.

It is all right for Portugal.

They have exported their doctors for oil to Venezuela. They do so in some areas in Africa for humanitarian benefits. However, it is a very repressive regime in terms of the suppression of civil society.

Sweden takes them.

These are issues the Deputy would raise with me if it applied to a different jurisdiction. We need a more open and honest debate about these things. There seem to be certain countries we cannot talk about at all. It is dressed up in idyllic terms. I have been to Cuba and they have a strong primary care system. However, the level of State control over individuals and over people is not something we in this democracy cherish or would endorse. The day that governments get to export their GPs - try that with the Irish Medical Organisation, IMO, someday here, say "lads, actually we are going to export you now." That is what has happened in Cuba for 50 years. When the Soviet Union collapsed, there was an increase in export of GPs from Cuba to get oil back in.

What is happening in Ukraine?

Oh no, please. We are way over time. That concludes Leaders' Questions.

I do not understand.

We are not going to get into it. We are going on to Questions on Policy or Legislation. Can Deputies, please, stick to the allocated time for the questions and the answers?

Top
Share