Dáil Éireann díospóireacht -
Thursday, 5 Nov 2015

Vol. 895 No. 2

Leaders' Questions

Deputy Dara Calleary

This time yesterday my colleague, Deputy Micheál Martin, raised the case of a 91 year old man who had been kept on a trolley in the emergency department in Tallaght hospital. The Taoiseach said he wanted to know who was responsible and described it as a shocking example of the dysfunctionality of the system. He has joined the Minister for Public Expenditure and Reform, Deputy Brendan Howlin, in being a commentator from the sidelines on the health service. There are several other stories today. An 87 year old woman was allegedly sexually assaulted when she was placed in an all-male ward because of overcrowding, which is absolutely cruel and callous. We all agree that older people, particularly at such a vulnerable time in their lives, deserve better and at least to be treated with decency and dignity.

In the past hour, in this morning’s edition of the Irish Daily Mirror and on "Today with Sean O’Rourke" another story was told which had the absolute worst outcome. It concerns the death of Dualtagh Donnelly because of ambulance delays in Dundalk. It took 39 minutes for an ambulance to arrive after he had severed an artery in his arm. He lived five minutes from the base station. He was a young man, the father of two young children, with another child on the way. Will the Minister ask for the case to be independently investigated in order that such a case can be avoided in the future? Mr. Donnelly's partner spoke very movingly and courageously on "Today with Sean O’Rourke" this morning and the family is to be commended for going public about its tragic loss. There are problems in the National Ambulance Service and delays all over the country. This will happen again, unless there is an independent investigation and lessons are learned.

The approach of Mr. Donnelly’s family is very different from that of the management of Tallaght hospital which states it will investigate Dr. Gray’s letter. It will not investigate why a 91 year old man was left on a trolley but the doctor and how his correspondence was released to the public. It seems it is not interested in the treatment of patients but in disciplining and silencing its critics and those who raise genuine cases of concern. Surely the management of a hospital should be worried about how it took 29 hours for a 91 year old to be given a bed in a ward rather than scapegoating a doctor.

The Minister has introduced whistleblower legislation and championed whistleblowers for many years. Does he believe Tallaght hospital’s approach is correct? Does he believe that, where they have issues of serious concern, doctors and medical staff should be allowed to bring them to management? Will he confirm that the incident at South Tipperary General Hospital took place, as reported this morning? Will he commit, on behalf of the Government, to initiating an independent investigation into the reason for the delay in the arrival of an ambulance for the late Mr. Donnelly in Dundalk?

Minister for Public Expenditure and Reform (Deputy Brendan Howlin)

I thank the Deputy for raising three discrete and separate issues. I will not have time to go into them in any great detail. Each has to be considered individually.

For some time the Government has been examining emergency departments in hospitals as a priority. That is why last December the Minister for Health and I discussed how to resource them and ensure there would be adequate resources to deal with the pressures on them. Last December the Minister for Health established an emergency task force. We tried to identify the impediments to ensuring people had access to beds quickly when it was determined in emergency departments that they needed them. We have deployed considerable resources to get what used to be called late discharges out of hospital into a more appropriate setting. That is why we have further resourced the fair deal scheme greatly such that the 16 week waiting time has been reduced to between two and four weeks. There are 1,200 additional home care packages in order that people can be treated at home rather than in an emergency or hospital setting. We have also opened additional beds.

Let us consider the individual cases about which the Deputy talked. With great respect to him, in the case of the 91 year old man, we need to respect the privacy of the individual. However, an aged person should not have been left on a trolley for that length of time. We need to understand why and how it happened. That is separate from the individual’s right to privacy which neither the hospital authorities nor the Government can ignore. However, we need to know exactly what happened in the case and why the person concerned did not have access to a bed.

In the very sad case of Dualtagh Donnelly in Dundalk I join the Deputy in expressing my sympathy and that of the Government to the Donnelly family. I understand the National Ambulance Service received the emergency call at 3.06 a.m. on Monday, 26 October. It was classified as life-threatening. The rapid response vehicle crewed by an advanced paramedic arrived at the scene 23 minutes later at 3.29 a.m. An emergency ambulance arrived at 3.45 a.m. While the emergency paramedics were en route, the National Ambulance Service call taker stayed on the line to give first aid instructions to the caller. On their arrival, the paramedics did everything they could for the patient, but, unfortunately and regrettably, he passed away, which is very sad.

On the third issue, the alleged assault in South Tipperary General Hospital, on 28 October a female patient was checked by medical staff. The Garda was called and it is investigating the matter. The male patient was moved to a side room and has been approved for long-term care and remains in hospital, where he is monitored 24 hours a day, seven days a week by security staff, pending acceptance by a health care facility appropriate to his needs. The matter is being properly investigated by An Garda Síochána.

As a former Minister for Health, I am aware that emergency departments provide front-line services for a variety of cases. Issues will arise, in respect of which we need full transparency. The Deputy is right that if anybody wishes to make a complaint about any matter, staff or not, it must be fully and completely independently investigated.

Deputy Dara Calleary

There are two accounts of the ambulance issue. It would be worthwhile and give comfort to the family if somebody independent were to investigate it, to talk to the family privately and talk through exactly what happened because there are lessons to be learned. This is happening everywhere. There are ambulance delays all over the country; we just do not hear about them, but we all experience them.

This morning the Minister of State at the Department of Health, Deputy Kathleen Lynch, used the word "chaos" about emergency services. It is the beginning of November and the delays and pressures arising in emergency departments normally do not surface until December or January. Mr. Liam Woods, national director for acute hospitals at the Health Service Executive, mentioned preparing and putting a winter plan in place.

Winter is here and its results can be seen in our accident and emergency units every night of the week now, not just at weekends. It seems to be continually pushed down the line, with people saying, "It is not our problem". The emergency task force has been branded a failure by the Irish Nurses and Midwives Organisation, even though nurses were at the heart of it. They are now balloting for a strike. The people on whom we depend for our emergency service have no confidence in the task force and are planning a strike and one of the Ministers in charge uses the term "chaotic" in respect of it. When is the Government going to take specific action to avoid these delays? They should not be happening at any time of the year but especially early in the winter when there is no pressure on the system in terms of colds, flu and other winter illnesses. How many more people are going to be left on trolleys for hours on end?

Deputy Brendan Howlin

Our responsibility as a national Parliament, and the specific responsibility of the national Government, is to ensure we have resources and staffing in place to deal with the health needs of our people.

Deputy Peadar Tóibín

They are not in place.

Deputy Brendan Howlin

In preparing for this winter, that is what we have been trying to do, not just this week but from the end of last year. Resources have been deployed and we took the advice of the task force on how we could relieve pressure on accident and emergency units. It advised us to provide more resources for the fair deal scheme and we provided €44 million in additional money for that this year. We introduced a specific initiative on waiting lists, costing another €51 million, and allocated another €30 million to delayed discharges and another €10 million for a winter initiative. In total, €135 million in additional money, which we have yet to vote on in this House by way of a Supplementary Estimate but will do by the end of this year, has already been deployed in order to relieve pressures in this area.

The question of staffing was mentioned. My job as Minister for Public Expenditure and Reform is to make sure we get a result from the significant and scarce resources we deploy in every area of public expenditure. We have employed 5,235 additional staff in the HSE since the beginning of 2014.

Deputy Dara Calleary

Why are they going on strike?

Deputy Brendan Howlin

We have 700 net additional nurses.

Deputy Dara Calleary

They are going on strike.

Deputy Brendan Howlin

Is 700 additional nurses not enough?

Deputy Peadar Tóibín

The outputs tell us it is not enough.

Deputy Brendan Howlin

What is enough? We need to have a debate on this. I know the normal, default position of Opposition is to say that, whatever there is, it is not enough and the Government must provide more. We must also have a grown-up debate in this House on how we deploy resources effectively and maybe one day we will. At the beginning of this year I asked each sectoral committee, including the health committee, to engage on these issues to see how we deploy resources effectively.

Deputy Dara Calleary

The Minister should take charge.

Deputy Brendan Howlin

We spend more money on our health services than the OECD average, though our health demographics are poorer.

Deputy Dara Calleary

It takes 29 hours to get a bed.

Deputy Brendan Howlin

Deputy Calleary is right - that should not happen.

Deputy Timmy Dooley

The Government abolished the HSE.

Deputy Brendan Howlin

It is no use running with a statement like that. We are interested in analysing the problems and providing solutions, as we have done in respect of every serious challenge we have faced.

Deputy Pearse Doherty

Across the State people woke up this morning to the horrific newspaper reports on our health services. An elderly woman, placed in an all-male ward due to overcrowding in South Tipperary General Hospital, was allegedly subjected to a horrific sexual assault. In another report we read of Dualtagh Donnelly, the father of two who, having cut his arm on a glass door, bled to death while waiting for 40 minutes for an ambulance to arrive. This is despite the fact that the family home where he lived was only five minutes from Dundalk ambulance station and close to Louth County Hospital, whose accident and emergency department has been closed. All these stories come on the back of the story we heard yesterday of the 91 year old man who was lying on a trolley for 29 hours in Tallaght Hospital. The Minister said the Government would address these problems but it is five years into its term of office, its last dying months. When is it going to fix the trolley crisis? When will it fix the crisis in our ambulance services? Dualtagh Donnelly may have been able to be on this earth today if an ambulance was there for him at the appropriate time.

These are not isolated instances. This House has heard different stories about delays to ambulances where they have been deployed without paramedics or where people have had to ask neighbours to drive the ambulance. We have heard of ambulances whose wheels have fallen off. The trolley crisis only gets national attention and prominence when it is a 91 year old person or someone aged 100 or more but should it be acceptable, in this day and age in our society, to allow a 50 year old or a 15 year old to spend 29 hours on a hospital trolley? The 91 year old to whom I refer was joined yesterday by over 400 individuals. Is it not time to accept that after five years in office, the Government has failed to deliver on fixing the health crisis? Is it not reasonable to accept that its failure to invest after stripping valuable resources out of our health service is the cause of what we read in our national newspapers today and have read on many other days in the past year?

According to the budget document, the Government has provided €18 million in additional funding for 2016 when demographic pressures and the Lansdowne Road agreement are stripped out, yet it provides multiples of that amount - nearly ten times the amount - in tax reliefs to those who earn over €70,000.

Deputy Brendan Howlin

Is this a question?

Deputy Pearse Doherty

The Minister may not want to hear it but I said on budget night that when he deploys policies like that, this is what we will get. We will get our elderly people on hospital trolleys and people dying in their homes because the emergency service will not get to them within the appropriate time. Does the Minister accept that the Government has failed spectacularly to deal with the crisis in our hospitals and accident and emergency services across the State?

Deputy Bernard J. Durkan

That is no question.

Deputy Brendan Howlin

The Deputy wants to look back five years and judge us on our performance over those five years.

Deputy Billy Kelleher

The Irish people have done that.

Deputy Brendan Howlin

The Irish people have not been asked yet and I would not be so arrogant as to pre-empt what the judgment of the Irish people will be.

Deputy Bernard J. Durkan

Hear, hear.

Deputy Billy Kelleher

The Minister will quickly find out when he goes knocking on doors.

Deputy Brendan Howlin

The Deputy can, like de Valera, look into his heart and know the will of the Irish people. Let me be honest and clear with the Deputy. If we had followed his prescription five years ago we would have had a collapsed health service by the end of 2011. We would have bankrupted the country and there would be no pay for nurses or doctors, never mind talking about increases. Let us talk some semblance of reality. We have worked to retain key, essential personnel. Since the beginning of last year we have had 700 net new nursing staff.

Deputy Pearse Doherty

There are more people, too.

Deputy Brendan Howlin

Medical and dental staff have seen increases of 10.5% since the beginning of last year. The number of medical and dental staff is now higher than the pre-crisis peak of 2007. We have now more dental and medical staff than we had when Mary Harney said we were awash with money.

Deputy Dara Calleary

Why is there an orthodontic waiting list? The Minister should read the list.

Deputy Brendan Howlin

This is despite navigating this country through the worst economic crisis in our history. The additionality to which I referred is €135 million. Most people listening to this debate will feel their hearts scalded by the two actual cases which have been referred to today.

Regarding the very sad case of Mr. Dualtagh Donnelly, as I have said, the advance paramedic in a rapid-response vehicle was there in 23 minutes. The 2015 target for a patient-carrying vehicle to be on scene is 18 minutes and 59 seconds for 80% of emergency calls.

Deputy Billy Kelleher

First responder.

Deputy Brendan Howlin

This emergency vehicle arrived in 23 minutes.

Deputy Peadar Tóibín

That is according to the HSE, not according to the family.

Deputy Brendan Howlin

That is the information I have. All these can be validated and checked. Let us wait for objective fact before we jump to judgment.

Deputy Peadar Tóibín

The Minister is giving one view.

Deputy Brendan Howlin

Let me give the full fact because, obviously, before coming in here I asked. There were eight emergency ambulances and two rapid-response vehicles operating in the north-east area on the night of this dreadful accident. The normal complement for the night is ten ambulances and two rapid-response vehicles. The reduction in capacity was due to short-notice absences on the night which I understand is not an exceptional circumstance. We need to look into these matters to ensure that the real concerns of the Donnelly family are fully investigated and ventilated.

The south Tipperary case is under investigation by An Garda Síochána, which was called. Again, we will wait for the proper investigation into that matter by the appropriate authorities.

Deputy Pearse Doherty

As I said, these are not isolated cases. The individual circumstances are obviously particular to these families, as are the tragedies that unfolded. We all know of different cases. Yesterday, there were more than 400 people on hospital trolleys and this is likely to continue. The Taoiseach's answer to this question yesterday was that things were likely to get worse and that we would hear of more terrible stories. Government Deputies have spoken about the inevitability that this will escalate in coming months. It is inevitable because of the policies the Government is pursuing but it is not inevitable that every day, we need to have 400 patients - 400 of our citizens - on trolleys on emergency department corridors or in hospital wards. It is not inevitable that we regularly have to have fewer ambulances available than should available.

The Minister stated that 20% fewer ambulances were available in that region than should have been available and that we had a death, more than likely, as a result of the failure of that ambulance to get there within the appropriate period of time. It took 40 minutes for that ambulance to arrive and yet the person was within five minutes of the ambulance station.

As the Minister pointed out, this is not unique to Dundalk. It happens in other areas, as we have known for the past five years. What will the Government do to ensure no other person loses his or her life as Dualtagh Donnelly did because of the lack of basic life-saving services in any region? Dualtagh Donnelly's mother Oonagh said, "I have that much anger in me, I feel my son died because of politicians' policies." It is hard to disagree with that. It is the Government's failure to deal with such issues, which are not isolated but are now systemic across Irish society, that is not just leading to the inconvenience of people having to spend a couple of hours on hospital trolleys or having to wait a couple of extra minutes for an ambulance service but is having implications for health outcomes, in some cases leading to people losing their lives. Does the Minister accept that?

Deputy Brendan Howlin

Let me be crystal clear. Health policy has been an absolute priority for the Government. The protection of health expenditure-----

Deputy Billy Kelleher

The Government does not have a health policy.

Deputy Brendan Howlin

The Fianna Fáil-----

(Interruptions).

An Leas-Cheann Comhairle

Sorry, it is Deputy Pearse Doherty's question.

Deputy Brendan Howlin

Fianna Fáil attacked me last year-----

Deputy Billy Kelleher

The Government has no health policy.

Deputy Brendan Howlin

-----for introducing a Supplementary Estimate in excess of €600 million for the health services.

Deputy Dara Calleary

The original Estimate was a lie.

Deputy Finian McGrath

The Government has been in power for five years.

Deputy Brendan Howlin

I believe its spokesman will attack me again for introducing a Supplementary Estimate.

Deputy Dara Calleary

The original Estimate was a lie.

An Leas-Cheann Comhairle

Please, Deputies.

Deputy Billy Kelleher

The Minister misled the House.

Deputy Brendan Howlin

We have put that €600 million into the base for next year and more money besides. We have done the analysis on how to alleviate pressure on emergency departments this year and have allocated €135 million to the individual-----

Deputy Pearse Doherty

Why is it not working?

Deputy Jonathan O'Brien

It is not €135 million.

Deputy Michael Colreavy

It is €18 million less.

Deputy Brendan Howlin

They do not want to listen. The Deputies opposite want to shout down the facts-----

Deputy Dara Calleary

We learnt that from the Minister's leader.

Deputy Brendan Howlin

-----because they are only interested in shouting about problems. They have no interest whatsoever in solutions.

Deputies

Hear, hear.

(Interruptions).

Deputy Brendan Howlin

They have no solutions. They have no policies for solutions.

Deputy Pearse Doherty

Some €383 million should have been allocated to the health services.

An Leas-Cheann Comhairle

The Minister is speaking.

Deputy Brendan Howlin

They thrive in the issues-----

An Leas-Cheann Comhairle

The Minister has the floor.

Deputy Brendan Howlin

They thrive in having no solutions.

Deputy Peadar Tóibín

Trolleys are not the solution.

Deputy Finian McGrath

The Government turns down solutions every single day.

Deputy Brendan Howlin

We have a very clear set of measures to deal with problems in emergency departments. Of course issues will arise, as the Taoiseach said yesterday. It is very complicated. It arises in every emergency service around the globe. If the Deputies opened their eyes, they would know that. I have had discussions with the OECD on international health care to review models that work, as the Minister for Health has done.

An Leas-Cheann Comhairle

I thank the Minister.

Deputy Brendan Howlin

A particular question was asked about ambulances. Some 64 new ambulances have been provided at a cost of €9.4 million.

Deputy Dara Calleary

They are all replacements.

Deputy Brendan Howlin

We need to ensure they are available-----

Deputy Billy Kelleher

We need additional ambulances.

Deputy Brendan Howlin

-----on rosters and that they meet the timelines we have set. We are determined to achieve that.

Deputy Pearse Doherty

We need actions, not words. We need actions, not more commentary.

Deputy Tom Fleming

Youth unemployment is still double the rate it was at the start of the recession in 2008. The latest EU labour force figures show that Ireland is one of the ten European countries where youth unemployment exceeds 20%. The EU survey also shows that 15% of Ireland's youth were not in employment, education or training last year. If we take into account the thousands who were forced to emigrate, the figures for youth unemployment would be well over 30%.

CSO figures published last month show an overall unemployment rate in September of 9.4% and we all welcome the progress made to date. However, at the other end of the spectrum, the seasonally adjusted youth unemployment rate, which is defined as covering 15 to 24 year olds without a job, is now at 20.06%. In addition, the live register figures indicate that 65,600 people of all ages were on activation and training schemes and these are not counted in the jobless total.

The PricewaterhouseCoopers survey released this week pointed out that Ireland is losing billions because we are failing to tap into the potential of our youth. It points to high levels of unemployment and low levels of participation in job training, vocational education and apprenticeships. The PwC report also concluded that core European countries such as Germany, Switzerland and Austria offer the best role models in developing the potential of youth through a system of education and vocational training. We are many years behind these other countries. It is obvious that we are not tapping into the potential of our youth.

What joint action are the Ministers for Jobs, Enterprise and Innovation, Education and Skills and Social Protection taking? There are huge deficiencies out there. What are they doing to minimise the number of people who are falling through the labour net with the various good schemes we need to address the matter?

Deputy Brendan Howlin

As the Deputy will know, the issue of job creation has been the absolute top priority for the Government since we came to office. We have reduced the unemployment rate from heading towards 500,000 when we came into office and 15.2% at its peak to 9.3% this week. This week's figures indicate that youth unemployment has fallen below 20% for the first time since 2009.

We are now at or just below the European average. We are not resting on our laurels; we have a job of work to do. There is a lot of joined-up thinking. A major initiative from the Department of Education and Skills will now, through the new ETB structure that we have established, focus on apprenticeships. An additional €10 million has been allocated to that area. There are a lot of young people who do not see the pursuit of normal academic degrees as their future. When one looks at a very successful country like Germany, it highly values apprenticeships and gives academic recognition to that. It is a path we are going to follow as well. I assure the Deputy that the issue of unemployment generally and youth unemployment in particular will continue to be the first objective of this Government.

Deputy Tom Fleming

This week's PwC report also pointed out that out of 34 countries surveyed in Europe, Ireland is ranked at No. 29. The league scores individual countries on their youth unemployment rates and their performance, for instance, in the vocational training to which the Minister referred. It is an indictment of our system that we are not catching up with the rest of the developed countries in Europe in tackling those issues.

We must acknowledge also that every effort should be made to facilitate youth, our greatest resource, and to channel young people into the proper training courses to meet the needs of industry. We must meet the needs of local SMEs and the needs of foreign direct investment companies, FDI, who are coming into this country and respond to the needs of the economy in general. We must also provide incentives and encouragement for the many emigrants whom we are striving to attract back to this country. The experience they have gained will be invaluable for the future of our economy. We must accelerate the programme to develop the skill sets and training, in particular vocational training to which the Minister referred. The industrialists who want to come into this country have pointed out the lack of the skill sets that are required for their specific enterprises.

Deputy Shane Ross

Hear, hear.

Deputy Tom Fleming

We must meet the needs in that regard.

An Leas-Cheann Comhairle

Could the Deputy please ask a question?

Deputy Tom Fleming

I am sure the Ministers to whom I referred are working together as cohesively as possible but we must step it up to a higher level. The Government must ensure that a survey is carried out on how certain European countries are getting such good results. We are lagging behind at the bottom end of the 34 countries surveyed.

Deputy Finian McGrath

It is all about the premierships.

Deputy Tom Fleming

That is a very bad and sad reflection on us that we have such a high percentage of youth unemployment and that we are not addressing the matter in a proper fashion. I urge the Government to look at the European experience and see whether we can learn from the likes of Germany, Switzerland, Austria, and the other efficient countries.

Deputies

Hear, hear.

Deputy Brendan Howlin

I again thank the Deputy and I fully agree with much of what he said. However, rather than rely on a PwC survey, the statistics I have given the Deputy are the official figures for this week from the CSO. I am pleased to report to the House that we are moving significantly in the right direction. One of the first things we did was to restructure the entire training platform by changing and abolishing FÁS and changing the nature and remit of the old vocational education committees. Instead of FÁS we have SOLAS and instead of the vocational education committees we now have the education and training boards, ETBs, with a new remit to deal directly with not only young people but people of all ages who need upskilling and training. SOLAS now deals with people who are unemployed for three months with bespoke, customised training based on their skill sets, desires and also the availability of job opportunities in their own region to provide for that.

I also assure Deputy Tom Fleming that the sort of joined-up thinking between the Department of Social Protection, the Department of Education and Skills and the Department of Jobs, Enterprise and Innovation that he recommended is being followed.

Deputy Finian McGrath

They are constructive ideas.