Dáil Éireann díospóireacht -
Thursday, 13 Apr 2017

Vol. 947 No. 2

Leaders' Questions

Deputy Robert Troy

The Government is trying to manage many serious challenges on many fronts, some with little success and others with none. Housing remains a national crisis which is worsening by the day rather than improving.

For the past 22 days, a bus strike has impeded people across the country and has had a detrimental impact on local and regional economies. A report yesterday confirmed that businesses across Cork lost up to €20 million in this period. Provincial towns such as Athlone, Mullingar, Thurles, Sligo and so on have felt the pinch. Businesses there have been down by approximately 20%. Retail Excellence Ireland, REI, predicted this morning that there will be job closures as a result of this strike. All of these losses and the strike itself could have been avoided if the Government had acted when it became aware of the financial difficulties facing Bus Éireann over a year ago.

Banks are pulling out of towns across the country. There is a threat of 250 post office closures. The lack of broadband delivery will leave half a million people waiting until 2023 for a service. These issues sum up and justify how rural Ireland feels neglected by the Government.

Worryingly, the chairman of Dairygold was quoted in today's edition of the Irish Independent as stating that if Brexit leads to customs and tariff controls, there will be decimation in rural Ireland with the cheese, beef, dairy, mushroom and drinks industry being seriously hit. If introduced, the World Trade Organization, WTO, tariffs on cheese will be €1,671 per tonne. The CEO of Dairygold said that this would be an appalling and frightening vista.

The negotiations on Article 50 start at the end of this month. Whatever emerges from the negotiations, Ireland will need a major programme to aid those who are worst hit. The agrifood sector is critical to our economy and will be the sector worst hit. The UK is already funding their businesses to protect supply chains and Ireland needs to do the same.

Can the Tánaiste confirm that the Government is requesting assistance from the EU? Does the Government have a plan for the agrifood sector, which employs tens of thousands of people across the length and breadth of the country?

The Tánaiste

Let me give another perspective to what Deputy Troy has said. The Irish economy continues to grow strongly. Growth is broadly based across the country and employment continues to grow in all sectors. Earlier this week, the Government published our draft stability programme update and the Minister for Finance, Deputy Noonan, will present that document to the Select Committee on Budgetary Oversight at 2 p.m. today.

Everyone is aware of the uncertainties on which the Deputy has commented but despite those external uncertainties, the growth forecast for 2017 has been upgraded to 4.3%, having grown at 5.2% last year. These are not just statistics. They have an impact on families' lives because the figures indicate that people are now working. Our debt position continues to improve. The rate of unemployment has dropped from a high of over 15% when Fine Gael returned to power in 2011 to 6.5% today. That means something to individuals and families. It has an impact on the quality of their lives. It means there are opportunities. We are able to continue to invest in the services people need because we have a growing economy. When Fianna Fáil was in government, all investment stopped. Unemployment was growing, the economy was in freefall and we had lost our sovereignty. All of that has now changed. That is the broader context, notwithstanding the challenges the Deputy points to in regard to Brexit and the changing economic situation.

There has already been a discussion in the House this morning regarding Brexit. The Government has a clear plan. The priorities of the Irish Government have been reflected in the draft paper which was published. There are certain sectors which will be particularly affected, including the enormous challenges which Brexit presents for the entire Irish agrifood sector. Negotiations are yet to begin but the Government will take a most robust approach to protecting vulnerable sectors. It has been recognised in what has been published to date that there is a special case and situation in regard to Ireland which must be considered in the negotiations. For example, in 2016, Irish agrifood exports to the UK came to €4.8 billion or 39% of the total agrifood exports. The Minister for Agriculture, Food and the Marine, Deputy Creed, and his officials are working on these issues. They are looking at the potential impact of the UK vote, the areas where the greatest risks may arise and the areas on which we will need to focus once negotiations begin. As I have said, the negotiations have not yet begun but the preparatory work has been done. The priority for Ireland is protecting our economy, including the very valuable agrifood sector.

Deputy Robert Troy

It is typical of the Government that the Tánaiste comes into the House and tries to take credit for every positive event over the past number of years. The Tánaiste has ignored the favourable international conditions from which the Government benefitted, the sacrifices made by men and women over the past number of years and the business people who are creating employment the length and breadth of this country with little help from the Government. We are still waiting for the Government to take corrective action on the issue of commercial rates, which has faced businesses in recent years. The Tánaiste chose to ignore the issues I raised about post offices, bank closures and the strike at Bus Éireann. It is not funny. It is not funny for the people in rural Ireland who rely on these services day in, day out.

I ask the Tánaiste a specific question about an EU stabilisation fund. Will Ireland be able to benefit from that? Will the agrifood sector, which generates tens of thousands of jobs but will be detrimentally affected by Brexit, be able to apply for that funding in the not too distant future?

The Tánaiste

All the points I raised relating to increasing employment in this situation impact on rural Ireland as well. The Labour Court is expected to make a recommendation today, and we want to see our transport services in place again as soon as possible. The approach the Government has adopted to this is that we want to see a resolution while encouraging all parties to be part of that.

The issue of post offices was discussed in detail here yesterday. The Government is taking a range of actions and initiatives, including on banking, in post offices that I hope will ensure that they will remain open in rural areas across the country.

As the negotiations develop, it is essential that the vulnerability of particular sectors will form a key part of those negotiations. From an agrifood perspective and given the importance of the United Kingdom, UK, market for the sector, our demand will be for continued free access to the UK market without tariffs and with minimal additional customs and administrative procedures and to keep the UK market viable for Irish producers by minimising the risk for many UK trade agreements. That is clearly the approach we will be taking and in that context we will be discussing the very point Deputy Troy raised.

Deputy Louise O'Reilly

The chaos caused by the Tánaiste's Government is starting to get out of control. Its mismanagement has led to chaos in our justice system, chaos in transport and chaos in governance, but perhaps the most stark and painful is the chaos in our hospitals. Waiting lists continue to soar. Exhausted and demoralised staff are leaving in droves, there is a dangerous lack of capacity in our ambulance services and there has been no let up. There has been no let up for the nurse finishing a 12 hour shift knowing that she has to go back to dealing with the consequences of this Government's mismanagement and chaotic attitude to health care.

Figures have been published by the Irish Nurses and Midwives Organisation. I want to thank it for publishing the figures because they are a valuable addition to our discourse on health. Very often, they inject facts which contradict the Government's spin. The figures show that March 2017 has seen the highest ever number of people on trolleys since 2006. For the benefit of those who have not heard, that is 9,459. In 2008, the figure was 4,700. Last month, 9,459 patients were admitted for inpatient care. A decision was taken by a doctor that they needed a bed and there was no bed for them. I remind the Tánaiste that it is only a short few years since her colleague, the former Minister for Health, now Senator James Reilly, gave a commitment that never again would we see 569 people on trolleys. In January, the Government was surprised by the influenza outbreak and the figure increased to over 600.

I believe that if something needs to be fixed we should stop what we are doing and do that. Clearly, reviews do not work. Committees do not work. Kicking the can down the road, and God knows that is one of the Government's favourite pastimes, does not work. The Government's winter initiative has not worked. The National Treatment Purchase Fund, the practice of the Government giving money into the private sector, crossing its fingers, closing its eyes and hoping that somehow that will improve the public service, has not worked and will not work in the long run. People need solutions that work.

Will the Tánaiste take the necessary steps to deal with the scale of this crisis? Will she listen to the voices of patients, carers, the workers and their representatives? Will she confirm for our elderly citizens sitting at home in fear that the Government will not means test the already overstretched home help service but that it will increase the number of hours available?

The Tánaiste

This Government has been and is taking action. The Minister for Health has a series of initiatives to improve our health service. The first point I would make is that it is the highest health budget ever at €14.6 billion, demonstrating the Government's commitment to investing the gains from the recovering economy I spoke about to improving the health services. There is increased demand, as the Deputy rightly points out, from a growing and ageing population. We have a series of new developments in drugs, for example, and the Deputy will be aware of the very welcome decision taken this week on Orkambi to respond to the needs of people who have cystic fibrosis.

As the Deputy knows, the Minister met with the INMO this morning, and it is worth putting on the record that over 80% of nurses voted recently to accept the Workplace Relations Commission recommendation.

In terms of improving our health service, the key issue is the recruitment of more nurses. Part of the proposals was that 1,208 fully funded new posts for nurses will be in place by the end of this year. Both the INMO and the Minister are working to ensure that we have that recruitment and retention. That is absolutely critical. There is a new Bring them Home initiative, increased supports for nurses who return here and further pre-retirement initiatives to ensure that we can retain the nurses we currently have. The Minister and the INMO are agreed on that. Over 80% of the nurses are agreed on it also.

I would point to other initiatives that have happened. We have seen the increased funding that has gone into home care for the very people the Deputy spoke about. Increased numbers of home care packages have been made available and there was additional funding of €18.5 million in budget 2017 to support the development of primary care services. This week, given the funding we now have for the National Treatment Purchase Fund, more than 2,000 people will get their appointments. That is now possible because that funding is available under the National Treatment Purchase Fund. Those are real people who need services.

I would point out to the Deputy also that the trolley numbers are down approximately 5% in the year to date. There are huge challenges but progress is being made. With the exception of one day, there was a decrease in the numbers on every day in April compared to the same time last year. The numbers range from a 3.6% decrease in waiting time on one day to a 27.7% decrease on another day. Progress is being made but there are huge challenges in terms of extra demands on our health services.

I totally acknowledge the distress that can and is being caused to patients and their families, and to front-line staff who have been working in extremely difficult circumstances, but a range of both budgetary supports and other supports are being made available. For example, with regard to an issue that was raised here frequently, in January and February of this year we had the lowest level of delayed discharges in recent years. Progress is being made but huge challenges remain.

Deputy Louise O'Reilly

In January, the numbers on trolleys hit a record level. The Government is fond of setting records. Unfortunately, none of them is very good or useful. The Tánaiste paints a rosy picture of all the things she would like to do and all the developments she says are happening. Would she like to go down to any of the 409 people waiting on trolleys today and tell them about her great plan because they cannot see it? I have already said that what the Government is doing is not working. It is clear there is a crisis in our health service yet the Members opposite seem to be more interested in the next leader of their party. The Tánaiste's eye is off the ball and her Government is letting down the 650,000 people who are on waiting lists.

The Government is letting down the 9,400 people who were waiting on trolleys in March. The Tánaiste cannot spin this as a good news story because it is not so she should not pat herself on the back for the Government's so-called achievements because it has achieved record numbers on trolleys. I again ask the Tánaiste whether the Government will commit to reopening beds, investing in primary care and recruiting the necessary staff. By that, I mean actually recruiting staff because between December 2016 and January 2017, the system lost 168 nurses. The Government's recruitment plan is not working.

The Tánaiste

The initiatives announced by the Minister, on which he is working, have his full focus. The INMO met him this morning to focus on the key issue of recruitment and retention. The plan that has been accepted by over 80% of nurses is important. I am certainly not complacent about the challenges and have said that. I have acknowledged that the distress caused to any one patient waiting on a trolley is one instance too many, but clearly these problems cannot be solved overnight. What I am telling the Deputy is that the initiatives and actions are in place to ensure we have continual improvements. It is very challenging. We have an increased population and an older population but the bed capacity review is under way and will be completed later this year. Discussions are under way with the GPs regarding contracts. That is another important building block towards ensuring that the kind of primary care we want to see in this country is in place. This in turn will lessen the pressures on our acute hospitals. There is no complacency. I understand the distress caused to any one patient who is on a trolley, but the Government is acting proactively to make a difference and improve our health service on an ongoing basis.

Deputy Brendan Howlin

We in the Labour Party were critical of last year's budget, particularly the determination of Government to use a huge chunk of money to give the equivalent of a cup of coffee back to some people rather than investing it in urgently needed public services. Inevitably, this meant that progress ground to a halt on things we were doing. There was no reduction in class sizes, there was insufficient funding for home care packages, there was no extension of free GP care for children and there was nowhere near the amount of money we need for capital investment. Having boxed itself into that corner, the Government knew it needed at least one signature policy for the budget. For weeks in advance of the budget, we were told that this would be affordable child care.

The overall direction chosen by the Minister for Children and Youth Affairs is correct. She believes in, and we support, the need to move towards a model of targeted universalism where all families get support, with additional support for those who need it most. It did not get enough funding to be truly meaningful, but some argued that we needed to start small to get it right. That would be fine but even this small limited start now lies in tatters. The Irish Examiner reports today that neither the legislation nor the IT system is ready. For weeks, I have been asking the Taoiseach for an update on this legislation. I never got a clear answer except to be told that it was urgent. Deputy Jan O'Sullivan warned back in February that the system was in trouble because Pobal had indicated that the IT systems were not in place to do the job. The Minister never answered that charge.

The reason neither the Taoiseach nor the Minister would give direct answers is abundantly clear. Having made political capital out of promising a child care scheme that would be progressive and help families who needed it most, the scheme will do no such thing. The existing targeted supports for the lowest income families will be retained but that is not progress. That is standing still. Now all that families will get is €20 per month in child care supports compared with a monthly cost in excess of €1,000.

I have two questions for the Tánaiste. What does she have to say to the tens of thousands of families who were led up the garden path by the Government in the lead-up to the last budget? Will she outline to the House the exact position regarding child care supports that will be in place and when they will be in place?

The Tánaiste

In respect of the first point about the economy, Deputy Howlin seems to have purged his mind of all memories of policies he so enthusiastically supported while he was at the Cabinet table. The Government will continue to honour its commitment to make child care more affordable for thousands of families - more than 70,000 children - by making a number of enhancements to the existing targeted child care schemes with effect from September 2017. We are determined to go from having one of the most expensive child care regimes to one of the best. Significant progress has been made. The Department of Children and Youth Affairs is working with various other Departments and agencies to build the fully automated online system-----

Deputy Brendan Howlin

Where is it?

The Tánaiste

I am coming to that. The Department of Children and Youth Affairs is working with various other Departments and agencies to build the fully automated online system which will provide a user-friendly means for parents to access child care supports. It will be much more efficient in terms of administration. Given the sheer complexity of this development and a number of other factors beyond the control of the Department, the Department will not now introduce the online system until a later date.

Deputy Brendan Howlin

When is that?

The Tánaiste

Early in the new year. From September, up to 33,000 children aged from six months up to 36 months and availing of registered child care will benefit from the new universal scheme. All children under the age of three will benefit from that. This will be in place from September. The maximum weekly subsidy payable will be €20 for children attending full-time care, which is €1,000 per year for those children. From September, another 23,000 children who are availing of child care supports under the community childcare subvention, CCS, programme will benefit from significant increases. These will be up to 50% in the subvention rates provided under the programme. Up to 7,000 additional children are expected to benefit from the programme from September due to improved access through a greater number of community and private child care providers participating in the programme throughout the country. I would remind Deputy Howlin that we have also brought in a second free preschool year, which will benefit-----

Deputy Brendan Howlin

We did that.

The Tánaiste

Deputy Howlin remembers that one. That is there now. Paternity leave has been introduced for the first time.

Deputy Brendan Howlin

We did that too.

The Tánaiste

More than 70,000 families will benefit from reduced child care costs from September. There is a group that because of IT issues in respect of accessing-----

Deputy Brendan Howlin

What about the targeted group?

The Tánaiste

One group will benefit shortly afterwards once the IT systems are in place. The full cohort will then receive the subsidies.

Deputy Brendan Howlin

It is extraordinary that the only positive things the Tánaiste has to announce are things done by the previous Government.

The Tánaiste

Budgeted.

Deputy Brendan Howlin

In terms of the specific commitment-----

The Tánaiste

That is not true actually.

Deputy Brendan Howlin

Not only the specific commitment but the signature commitment of last year's budget will not happen. That was clear in February. We knew there were going to be problems with the scheme because Pobal told the Government so during the pre-legislative scrutiny. The Government has had since February at least to be honest with people and tell them this would not happen in the timeline set out in the budget. I am still not clear about when this will happen for all targeted children. When will we have the announcement that was made in the budget on the revised child care supports that were supposed to be funded in 2017 and which will not now be delivered in 2017? When will they be delivered?

The Tánaiste

I have already mentioned the numbers of new children who will benefit from the increased child care that is available. That is the first point. There is a scheme there that will benefit far more children and there will be a greater level of subsidisation, something which was allowed for in the budget. They are new policies and it is important that they are being implemented.

In respect of the Deputy's question, we will need some legislation and an IT system. The Minister is examining that legislation and regards it as a priority. Work is being done on the IT system that needs to be in place to reach that group of families. When that has been done, using existing levels of investment, a further 9,000 families will benefit from more affordable child care through child care subsidies of up to €12 per week.

Deputy Catherine Connolly

Thirty-three years ago, in 1984, such was the concern about the mental health services that the central recommendation of the major new document, Planning for the Future, proposed a new model of mental health care. Between 1984 and 2006, there was concern at the slow implementation of the policy and in 2006 - nuair atá an Tánaiste réidh - A Vision for Change was published. This document detailed a comprehensive model of mental health service provision for Ireland for the ensuing ten years, including providing a framework for building and fostering positive mental health across the entire community and providing accessible community based specialist services for people with mental illness. In other words - má tá an Tánaiste in ann éisteacht - it told the Government exactly what to do. A Vision for Change told the Government what to do and how to do it but because its authors knew it would not happen, they made a strong recommendation that an independent monitoring group be set up because the Government, like all institutions, simply cannot be trusted. The implementation body was set up. It sat for two periods, that is, from 2006 to 2009 and from 2009 to 2012, when it monitored and assessed. It comments that the implementation of A Vision for Change was not up to scratch. The implementation body did such a good job in highlighting the slow and inconsistent implementation of the policy document that the body was disbanded.

Separately, year after year the Mental Health Commission has drawn the Government's attention to the failure to implement properly, fully and comprehensively A Vision for Change. In its 2016 report, the commission confirmed that A Vision for Change remained the national mental health policy. The document is to be praised. It highlighted recovery, person-centred approaches, partnership, user and family involvement and the delivery of services in a multidisciplinary community basis. A Vision for Change ran until January 2016. The Mental Health Commission has pointed out that while the vision of the document is excellent, the implementation was certainly not up to par. More importantly, the commission reiterated the need for an independent monitoring of A Vision for Change. Five years have passed without any independent monitoring mechanism. We are one year and three months after the promised review of the existing A Vision for Change. I have no idea what the difficulties are in this regard. I have raised it with the Tánaiste and I have raised it in the Dáil ten times but we still do not have the promised review or the implementation body, which is absolutely essential.

The Tánaiste

I thank the Deputy for raising this very important issue, one that is a priority for the Government. Mental health remains a key care programme priority for the Government. This is reflected in the fact that the mental health budget for the HSE has increased from approximately €826 million in 2016 to approximately €851 million this year. That is important because we know there are unmet needs in the State in respect of mental health services. Importantly, the stigma around mental health issues is decreasing and this is particularly noticeable among young people with the initiatives being taken in schools and by the supports these give to young people with mental health issues. There are some wonderful changes in the country in that regard.

A Vision for Change was the first important seminal document that laid out what we needed to do and that described the kinds of mental health teams needed for children and adults. A Vision for Change is still being implemented. I acknowledge that Deputy Connolly has asked this question in the Dáil previously. I am glad to be able to confirm that the Minister of State, Deputy McEntee, has informed me that the first stages of the review will be published within two to three weeks. Once published, the implementation group will be established immediately. This is currently under way.

The review will identify current gaps and it will publish plans to move towards having services available for 24 hours every day of the week. This is very important as access to emergency help or out-of-hours services is a huge issue in mental health. These issues will be addressed.

As Deputy Connolly knows, there have been a lot of developments. If one looks at what has been happening in the area of child mental health services, one sees that the funding prioritised by the Government has allowed new teams to be established. We now have 67 child and adolescent mental health service, CAMHS, teams nationwide, which is a huge improvement compared with the situation some years ago. We have three paediatric liaison teams. These are a very important part of the service because they provide the link between paediatrics and the mental health teams. There are 66 operational CAMHS beds across the country and we are planning to have further inpatient beds for children and young people with mental health issues.

The direct reply to the Deputy's question is that the review report will be available in two to three weeks.

Deputy Catherine Connolly

I thank the Tánaiste for letting me know when the report is to be available but it is not clear what will be the nature of that report. It seems to be the first stage in a further long process. The seminal document on mental health goes back to 1984 so there are no congratulations here. When we are talking about stigma and what is available, the difficulty is that all of this was recognised back in 1984 and re-recognised in 2006. There was nothing wrong with A Vision for Change. It is a brilliant document. It sets out everything. It sets out the figures in respect of suicide, which were at crisis point in 2006 and are significantly worse now, particularly in Galway city and county. We do not need any more statements in the Dáil. Members have been making statements about mental health but want an implementation of the document and want the independent body to be set up. If the Tánaiste is confirming this, then it is progress and I welcome it. We need absolute clarity on the review process and we need an implementation body similar to the previous body - and independent of the Government - to monitor the implementation of the existing A Vision for Change and any new changes.

The Tánaiste

Deputy Connolly is absolutely right in that we do not need to reinvent A Vision for Change completely. It was an excellent document and it provided the basic architecture for the development of mental health services in Ireland. More than 80% of the recommendations have been implemented but as with other areas of the health services, a key issue is the recruitment and retention of staff. I have already shown the Deputy the improvements that have been made in the areas of child mental health, for example. The same is true of the adult mental health services. There is further work to be done.

The first stage of the review, to be published in two to three weeks, will address the issues. The review is an evidence-based report and is based on experience internationally and in Ireland. This will influence the further implementation of A Vision for Change. It is about continuing to implement what was originally outlined in A Vision for Change but bringing it up to date and accelerating some initiatives, especially the provision of a 24-hour service seven days per week.