Topical Issue Debate

We will resume now with the Topical Issue debate. The first Topical Issue is from Deputy Frank O'Rourke, who has four minutes to make his case.

Housing Assistance Payment

I welcome the opportunity to raise this issue in the Chamber today. The housing assistance payment, HAP, scheme is a short-term interim solution for people who are looking for a permanent home. It is a support measure for those people who cannot afford to rent in their own right and who are on their local authority's housing list. I am from County Kildare and my constituency of Kildare North is in the commuter belt. Accommodation in the area is much sought after for positive reasons and there are currently approximately 8,000 people on the housing list in Kildare, which is a massive number. Those on the housing list need support and assistance in finding a permanent home, either through the local authority or by some other means. We all know that there is a shortage of supply and there is no point in me dwelling on that point because it has been dealt with extensively in this House. When one has a shortage of supply and a scarce commodity, the cost of that commodity will increase. In that context, we have a number of options if we want to prevent people from becoming homeless and to help those who are homeless to find a home. We can let them carry on as they are and do nothing while we wait for the supply to increase or we can review the current support mechanisms, which are not working in the case of County Kildare, and try to provide better support to people in order that they can access private rental accommodation.

We must be honest and acknowledge that private rental accommodation is the only show in town for those who are on the housing list and seeking accommodation. In respect of those who show up to for viewings, for every family that has been approved for rental support there is another family that does not need such support, which is positive from the perspective of the latter. However, the people who have qualified for HAP and who are on the housing list are at a disadvantage. The Taoiseach acknowledged earlier today in the House that accommodation is very hard to come by. We have all acknowledged that but now we need to do something about it if we are serious about preventing people from becoming homeless.

The HAP scheme payment for a single parent or a couple with two children in County Kildare who are looking for a three-bedroom house is €1,260 with 20% discretion but the current rental price for such a house in any part of north County Kildare is approximately €1,450, so they are already around €200 behind the line. They also have to pay differential rent to the local authority based on their income. In these circumstances, they are at a severe disadvantage in terms of securing private rental accommodation they can afford. They are starting off way behind the line. This is leading to an increase in homelessness and the situation is getting worse. Even when the people who qualify for the HAP scheme view properties they know they will not be able to access them because the payments are inadequate. I ask that those payments be reviewed in the short term until supply increases.

There is also an issue with regard to the administration of the HAP scheme. It can take up to three months for a payment to come through after one applies for the HAP scheme. This also puts HAP applicants at a disadvantage vis-à-vis those who do not need rental support and who show up to viewings with a month's rent and a month's deposit in hand. Landlords or landladies are not going to wait for three months for a payment. If we are serious about dealing with homelessness we must help families to remain in their homes and we must also help families to get off the street. The Government must take this issue seriously and review the HAP scheme. We must do more to help homeless families to access homes.

I thank Deputy O'Rourke for raising this issue, which I am dealing with on behalf of the Minister, Deputy Eoghan Murphy, who cannot be here today. I will begin by addressing the last point that the Deputy raised regarding the delay in the processing of applications for HAP. The point he makes in that regard is a fair one and I will certainly take up that issue because local government is in my remit. A reduction in the processing time is an objective that can be achieved. That would greatly help people who are trying to put a roof over their heads.

The housing assistance payment, HAP, scheme plays a vital role in housing eligible families and individuals. There are currently more than 29,800 households having their housing needs met via HAP and more than 20,000 landlords and agents in receipt of HAP payments. A weekly average of 348 HAP tenancies have been set up during 2017 and over the past five weeks, the average rate has been more than 420 per week.

As part of an A Programme for a Partnership Government commitment, the HAP rent limits were increased significantly by the Government in July 2016, and by up to 60% in some areas. The Government also provided local authorities with statutory flexibility to exceed the maximum rent limit by up to a maximum of 20% where necessary, and 50% in the case of eligible homeless households in the Dublin region. Both of these measures are allowing HAP households to find suitable accommodation and willing landlords.

The local authority can determine, on a case-by-case basis, what level of support to provide, based on the tenant's current position and the needs of a household, as well as the market rents in that local area. It is also open to authorities to take a consistent approach in regard to the provision of discretion in particular high-demand areas or in regard to a particular household type that might be faced with a shortage of suitable property in the area in which they wish to live.

From available data, at the end of the second quarter of 2017 - excluding the additional discretion available to eligible homeless households in the Dublin region - 12.6% of HAP households nationally were benefitting from the flexibility introduced by the Government in 2016 to exceed the rent limits and the average level of payment agreed stood at 14.9% beyond the rent limits. In the administrative area of County Kildare, 432 of the 1,128 households supported by HAP at that point, or approximately one in three households, were benefitting from the additional flexibility, with the average level of payment being agreed at approximately 13% beyond the rent limits.

To address one of the particular difficulties in this area, local authorities are cognisant that increasing the HAP rent limits in particular areas could have further inflationary effects on the private rented sector, which could have a detrimental impact on the wider rental market, including for those households who are not receiving HAP support but are renting privately. In this respect, any changes to the HAP rent limits could have a significant knock-on effect on the other measures taken by the Government in regard to the wider rental market, such as the rent pressure zones that have been introduced to moderate rent increases in those parts of the country where rents are highest and rising, including Newbridge, Naas, the Deputy's area of Celbridge-Leixlip and Maynooth.

In general, HAP applicants should be sourcing accommodation within the rent limits and the discretion available. The data reported by local authorities show this is happening, by and large, and people who can benefit from HAP are able to access accommodation within the support limits in place.

With due respect, there is nothing in that statement. Everything the Minister of State has said in his statement is what I acknowledged in my opening presentation to him. If we are serious about dealing with the issue, we have to agree to reviewing it. It is just another issue. The Minister of State comes into the Chamber, as do his colleagues, including the Taoiseach, and say they are serious about dealing with the issues of homelessness. I will take him at face value-----

I never mentioned homelessness.

He mentioned helping people find a home or a house. We can be flippant about it, if the Minister of State wants. I am asking him why people are homeless. Let us analyse that. The first reason people are homeless is that local authorities, through Government policy, are not providing them with a social house. Second, people cannot access private rental accommodation because the limits are less than market value. I am well aware of the consequences of doing it, but if we are not going to review this scheme and provide help to such families in the affected counties, rather than nationally, then we are saying to them that we are sorry but can do nothing. If the current market value is, for example, €1,450, and the discretion to which the Minister of State refers and which I have factored in is 20%, this brings it to approximately €1,250. We are saying the person is starting off over €200 behind the line. We know that and acknowledge it but we are not going to do anything about it for the moment, until stock comes into the market, which is at least two or three years away.

I can see how seriously the Minister of State is taking this matter. Kildare County Council officials have raised this with the Department and have identified that this is a real problem for parts of County Kildare where HAP is not going far enough. This is adding to the homeless issue and adding to the number of people on the housing list who are not able to access the private rental market because it is unable to provide houses for them. The question we have to ask is whether we want to help these families. If we want to take them out of hotels and temporary accommodation or out of overcrowded family scenarios and provide them with some sort of short-term stable environment, I ask the Government to consider reviewing the points I have raised.

The Deputy might learn some day that when he asks a direct question, he gets a script from the Department. In order to give accurate information, Ministers are requested to do this. The Chair will know that other Members, including Deputy O'Rourke, are not supposed to have scripts when they are speaking in the House but that is a Standing Order that is not observed by anybody.

In regard to the seriousness of the matter, I have never had a discussion with the Deputy before and he clearly does not know anything about me. I know north Kildare very well and I know people who are involved in building in north Kildare. Before he entered the House, Deputy O'Rourke was involved in construction himself, as far as I remember. He knows the shortages that exist in north Kildare, despite the pure failure on his part to observe anything I said in my response. I opened my comments by saying that his point about the delay in processing applications was a valid one. He went on to completely ignore that acknowledgement and also the wider implications for those in private rented accommodation that could come if there was a significant change in the HAP scheme.

I indicated all along, including at the start of my comments, that there will be a review of the HAP scheme. The Minister, Deputy Eoghan Murphy, has said many times that the housing options that are available to local authorities and individuals are under constant review. Deputy O'Rourke was a member of Kildare County Council and has not been a Member of this House for long. He might go back to Kildare County Council and look at the €6 billion in funding that is available from the central government to provide local authority houses. He might also reflect on the time before he entered politics, when he was building houses and when Fianna Fáil introduced legislation to privatise the building of public houses in this country - Part V and Noel Dempsey. Does he remember that fellow? I remember him. I used to come up against him when I was in the Seanad at the time. When the backside fell out of the private building sector in this country, there were no public houses that could be provided because Fianna Fáil had given the job to private sector people who were involved in construction, like the Deputy.

I think there is plenty for the Deputy to reflect upon. I am one of the fairest people the Deputy will ever meet in this House but to accuse me of not being serious about my job and to have such a lack of understanding about responses to parliamentary questions and Topical Issues shows a degree of ignorance that ill suits somebody representing the people of north Kildare.

I will have to interrupt you. We must move on.

EU Bodies

I want to raise the issue of Ireland losing out on Monday on both the European Medicines Agency and the European Banking Authority. I have no doubt we are disappointed. Obviously, Ireland pulled out of its application for the European Medicines Agency in order to focus on the European Banking Authority but it is very disappointing. The European Medicines Agency had some 900 staff working for it but, more than that, tens of thousands of people come to it every year for meetings, conferences and so forth. The European Banking Authority is smaller, with only 167 staff, but it would have been a very useful signal to the world in terms of Ireland as a centre for financial services and as a centre of strong regulation in financial services, which is something we need.

I was quite surprised to hear how it finally went. Dublin got down to the last three and then, in voting, actually did better than Frankfurt, which is a great testament to the diplomats and all of the effort involved.

In the last round of voting, Ireland got more votes than Paris, which is where the authority ultimately went. Despite this, agreement was somehow reached that the location for the European Banking Authority, EBA, would be pulled out of a hat. Essentially, a coin was tossed. I am sure that the Minister of State shares my disappointment that Ireland felt that it had to pull out of the European Medicines Agency, EMA, bid and lost to Paris on a coin toss on the banking authority.

For Ireland, Brexit is mainly bad news. We are in risk mitigation territory and the stakes are getting high in terms of Northern Ireland and border controls. As such, I acknowledge the diplomatic efforts that were made. The purpose of this debate is not to have a go politically, but it is a serious issue that we have lost out on this and it needs to be discussed by Parliament. I am most keen to try to understand what we can learn. I do not doubt that our diplomats did an excellent job, but we lost on both bodies. We should have won one, given that we have a decent centre for financial services and a considerable number of large pharmaceutical firms from across the world. There is a great deal of research and development and manufacturing taking place in Ireland. Our partners in Europe recognise that we are the most exposed to Brexit. While we withdrew our bid for the medicines agency, perhaps for good tactical reasons, we had a strong political and technical case for hosting it.

I want to try to understand what we can learn from this. Many businesses, organisations, jobs and economic activities will leave the UK or are in the process of doing so. We must ensure that Ireland is placed as well as possible. My understanding is that, while jobs in financial services are coming over, they are not at the level that was expected. When I speak to financial services professionals in London and Brussels, they are surprised that many of the big names did not come to Ireland. Professionals in London told me that Dublin had been at the top of the list for many of these names, yet they decided not to come here for various reasons.

Between the two agencies, how many jobs has Ireland lost out on? Will the Minister of State outline where we scored well and where we fell short in the evaluations? In terms of the banking authority, were Ireland's regulatory capabilities an issue? Was housing an issue, in that, if we had brought over 900 people from the medicines agency, would they have had somewhere to live? Was the cost of living an issue, specifically housing, rent and child care? Were locations in Ireland other than Dublin considered for these two bodies? What does the Government believe we can learn from having tried hard and failed in order that we can increase our chances of securing other economic activity as Brexit unfolds?

I thank the Deputy for his questions. I have a script, but I will not read it. Instead, I will discuss what we went through for a few minutes and then answer the Deputy's questions.

Approximately two months ago, I started what was effectively a road trip. In that time, I have been to 16 European countries. This was done to put boots on the ground, meet finance Ministers and try to put forward the best case that we could for the EBA. At the same time, the EMA was being pursued by officials from the Department of Health. Perhaps a month ago, we made the determination that we would not win the EMA. We had a choice between pursuing two bids or one. Had we pursued two, we were of the view that we would not get into the round of three on either. That calculation turned out to be correct. We put in place a strategy to try to win one of the bodies. A country could only win one; none could win two. If a country won one, it would be excluded from hosting the second.

We withdrew from the bid for the EMA because we had always believed that we had a greater chance of winning the banking authority. That is why we prioritised it. We put boots on the ground. I thank the officials from the Department of Finance and, in particular, the Minister of State, Deputy McEntee, who put in a big shift, the Minister for Foreign Affairs and Trade, Deputy Coveney, and the Minister for Finance, Deputy Donohoe, because the process was operated strongly for between four and six weeks. We did everything we could to win one of the authorities.

I will try to answer as many questions as I can. The EMA and the EBA comprised approximately 900 and 200 jobs, respectively. One of my first visits was to the banking authority in Canary Wharf. Deputy Donnelly spoke about the bid, but this effectively turned out to be a political decision. The Commission carried out different types of assessment in respect of the EMA and EBA. It used a traffic light system for the former but not the latter, where it said that everyone was qualified. I never encountered questions about our regulatory capabilities when visiting the 16 capitals. Similar to the assessments performed by the Commission, issues of housing and the cost of living were not raised. No city in Ireland other than Dublin was considered. Primarily, the cities presented were capitals - Warsaw, Vienna, Paris, Brussels, Luxembourg, etc.

As to what we have learned, I will not pretend. Along with officials, I spent a large amount of time travelling. I believed that we could get into the round of three and that, if we were up against Paris and Frankfurt, we could win. I turned out to be incorrect. We did not win, but we did not lose. It went to the toss of a coin. We have learned a major lesson. There has been reportage on it, some inappropriately negative. People have been saying that we have no friends. We went head to head against Germany and France. They are much larger countries than ours. We beat the Germans and, when their votes were distributed, we were level with the French. The French did not beat us. It was a hell of an achievement. I thank the officials in the Departments of Finance and Foreign Affairs and Trade.

I will finish on one point. Our ambassadors and diplomatic corps on the ground have been superb. Their work probably goes unnoticed to some extent. They are professional and very capable. As such, I thank Deputy Donnelly for viewing this issue in a positive light. It is easy to take the Roy Keane view that, if we do not win, we lose. We were not beaten and we did not win. It went to the toss of a coin. I am disappointed that we did not win on the toss.

I thank the Minister of State for putting his script down. I appreciate answers to questions.

I will go into some of the specifics on the banking authority. My understanding is that we were offering approximately €13.5 million in rental support and a further €1 million to help staff relocate. As such, some hard numbers were involved. Based on the scoring mechanism or the political considerations, might offering more money have tipped the balance?

Has there been any ask of France? Maybe I am being naive in even asking this question, but France has a larger economy than Ireland and it is much less exposed to Brexit than we are. Were there diplomatic or senior political efforts to tell the French that, although they had been pulled out of the bag, this would have been ten times more important to us in relative terms and, in the spirit of egalité and fraternité, ask them to consider something else?

Regarding the process of Paris being pulled out of a bag, which was essentially a coin toss, my understanding is that we scored better than Paris when Frankfurt was knocked out. The Minister of State is saying that is not the case.

Was the Government okay with pulling it out of a bag? Should there have been more diplomatic efforts to make a case for Ireland, in particular in the context of Brexit?

I referred to potential earnings. I acknowledge that the Minister of State and diplomatic team did their best and raising this issue is not about having a go at them. We have lost the Rugby World Cup, the European Medicines Agency and the European Banking Authority, despite having really good people on all of those teams trying to sell Ireland. There is a big sell we need to start winning on. Financial services, engineering and professional services jobs, as well as all manner of other jobs, are coming from the UK and, it is to be hoped, other places. We are under pressure in terms of FDI and the US. We need to learn from our losses and start winning. Does the Minister of State have any reflections on things which team Ireland can start to do in order to get more jobs into the country? We really need them.

I will not have a conversation about FDI. Perhaps we could have that conversation if the Deputy tabled another Topical Issue matter. I do not say this very often, but I am absolutely satisfied that there was nothing more we could have done. To be frank, we pulled out all the stops. Everybody who was asked to participate did so really well. Many people did not believe we were in the race for the European Banking Authority. Many were of the view that we had made an error withdrawing from the European Medicines Agency bid. However, we said this was the only pathway for Ireland to get into the race for the European Banking Authority third round. We said that if we got into that we would be very competitive, and we were.

We had 13 votes after the second round. The French had ten and the Germans had four. The Germans were subsequently eliminated and its four votes were to be distributed in the next round. One country chose to abstain by spoiling its vote and the French then got three votes. It was 13 all and it went to a hat. That was agreed beforehand. I am not sure whether Deputy Donnelly is aware that the European Medicines Agency also went to a hat. Milan and Amsterdam went into a hat before us at 13 all. They are the facts.

More money would not have made a difference. We had a really good offering in terms of property solutions and staff relocations. Money did not become the deciding factor. Rather, it involved politics and larger countries, whereby Germany and France combined to level with Ireland. All three German votes went to the French. The core levelled with the periphery. That is the new dynamic and it is very interesting. Perhaps we will have a chance to have a coffee after this debate. That is the really big story in the European Banking Authority and European Medicines Agency because the Dutch, a smaller nation, also beat the Italians, a larger nation, and that vote was 13 all.

Hospital Services

I, along with my colleagues, wish to raise the issue of the Midland Regional Hospital in Portlaoise, specifically the action plan which has recently come into the public arena. I wish to put on record my disappointment that the Minister for Health, Deputy Simon Harris, is not present for the debate. He has responsibility for this issue. Given that four Deputies are raising the issue, it would have been far better for the Minister to be here. We will have to seek a mechanism to arrange a debate to ensure the Minister is here the next time.

We have serious concerns about Portlaoise. Before considering these, we have to look at the overall national context in which the report was prepared. There are 685,000 women, children and men on waiting lists for surgery and outpatient treatment. The waiting times in many of our hospitals are totally unacceptable by European standards. Every accident and emergency department in Ireland is overcrowded. People are on trolleys in the majority of them most days. The ambulance service is creaking at the seams. That is the context in which the report was drafted.

The report refers to closing the emergency department, maternity department, paediatric care unit, intensive care unit and all inpatient surgery in Portlaoise. The regional manager effectively only sees Portlaoise as a glorified health centre dealing with minor injuries and day procedures. Did those involved in the report think of the national context when drawing it up? It totally ignores the position of our health services throughout the country. The report is fundamentally flawed because it lacks an appreciation and recognition of the overall national position. For that and no other reason, this report must be rejected.

I concur with Deputy Fleming. It is very disappointing that the Minister for Health, Deputy Harris, is not present to deal with such a serious issue.

If proposals are introduced by the Government to downgrade Portlaoise hospital, lives will be put at risk. There will be a knock-on effect on other hospitals, such as the Midland Regional Hospital in Tullamore. The emergency department in Tullamore Hospital has already been in crisis. For example, the emergency protocol was activated three times last year, a measure only used as a last resort.

There is no way that the hospital’s emergency department could cope with an extra intake of patients. Common sense and decency need to be exercised in respect of the emergency department in Portlaoise. It must be retained. Ill patients will be put at serious risk if the downgrading goes ahead. Surely it is high time to set about improving our hospital services, rather than downgrading them. Resources should be provided to all hospitals in the midlands region. We cannot pit hospitals against each other.

We are in the midst of chaos in our health service. It would be nothing short of reckless to pursue an action which would have dire consequences for patients. Such an action would also put our hospital staff, who are already under serious pressure, under much greater strain. People are very concerned and I want this matter passed onto the Minister, Deputy Harris. I ask that the Minister make a commitment that the emergency department at Portlaoise will not be downgraded. To do otherwise would put people at risk.

I thank the Office of the Ceann Comhairle for selecting this very important matter. As the Minister of State is aware, there has been great concern in Laois and south Kildare regarding future health care services in Portlaoise hospital. Many of my constituents view the emergency department in Portlaoise as their natural place to go when there is a need to attend such a department. Many have used maternity services in Portlaoise, including people living in Kildare and along the border. From Athy to Monasterevin, Newbridge, Portarlington, Jamestown and Killenard, people see Portlaoise as their local hospital for emergency department, intensive care unit and maternity services.

First and foremost, we must ensure that we have the safe delivery of services and that the services available to the people of Laois and south Kildare are of the highest standard. Previous HIQA reports showed deficiencies and risks to patients following the death of baby Mark Molloy. I recognise the update from HIQA last December, which pointed to maternity services now being improved and delivered in a safer way, but there are still issues with understaffing and the recruitment of non-consultant doctors.

HIQA has pointed to the need for a strategic plan for the hospital and its future. A report was leaked to the media which is causing major concern in the area. The people of Laois and south Kildare need and deserve a number of things. We need clarity as to the future plans for Portlaoise hospital. We need the safe provision of health care services and a plan for the delivery of increased investment to ensure the safe provision of emergency and maternity services for the people of the area.

It is very disappointing that the Minister, Deputy Harris, is not here to address this issue. This is not the first time he has not been present when important debates on Portlaoise hospital are taking place. Only a week ago, he failed to turn up for another debate on it.

This hospital is on my doorstep. I have campaigned with others for over 20 years because of the constant threat to downgrade the hospital. Dr. Susan O'Reilly, who headed up the preparation of the report that was hidden for a number of years, has said she is now willing to engage in public consultation. She is talking from both sides of her mouth as the decision has been made and she is ploughing on with this. According to her, the only concern is the low volume of patients going through critical care in Portlaoise. Answers have been put forward by local doctors in response.

The first plan was leaked to me almost four weeks ago and one was leaked to the The Sunday Business Post and they spell out exactly what is supposed to happen. The minor injury and medical assessment units will operate in the day time. The paediatrics, maternity and the intensive care units will be gone. According to The Sunday Business Post leak - these leaks are deliberate - 12 hospitals, including Portlaoise, will stop taking trauma patients and major trauma centres will be created in Cork and Dublin. What absolute insanity. Does neither the Government nor the Health Service Executive understand the need for a regional network of emergency units staffed and equipped to a modern standard?

Dr. O'Reilly has not taken on board the need for the "golden hour" to be taken into consideration. This is the hour after a serious trauma, accident or injury. She has not explained how these patients will be transported to Dublin, Cork, Tullamore or anywhere else. The question is whether a patient is safer in the back of an ambulance or, in the first hour, getting to an accident and emergency department such as the facility in Portlaoise, which is well-established, well equipped and properly staffed. There is also a shortage of ambulances, with only one ambulance in County Laois on Monday and Tuesday nights. Will the Minister of State address that?

I thank Deputies for raising this matter. At the outset I reassure the Deputies that, as my colleague the Minister for Health, has stated, the most important issue in the consideration of services at the Midland Regional Hospital, Portlaoise, is that patient safety and outcomes must come first. The Minister, Deputy Harris, is committed to securing and further developing the role of the Midland Regional Hospital, Portlaoise as a constituent hospital within the Dublin Midlands hospital group. He has said he will bring clarity to this matter in the coming weeks.

Reports on Portlaoise hospital in recent years have pointed to the need for restructuring of some services to ensure patients are treated in the most appropriate setting by specialist staff who can safely meet their needs. Since 2014, the focus has been on supporting the hospital to develop and enhance management capability, implementing changes required to address clinical service deficiencies and incorporating the hospital into the governance structures within the Dublin Midlands hospital group. Significant work has been undertaken to strengthen and stabilise current arrangements for services at the hospital to ensure services currently provided that are not sustainable are discontinued and those that are can be safety assured and adequately resourced. The HSE has confirmed that hospital funding has increased by 28% relative to the 2012 budget and staffing levels have risen by 29% from the 2014 base. Funding of €300,000 has also been provided in 2017 to facilitate the opening of the new medical assessment unit. In addition, governance and management arrangements in Portlaoise hospital have been strengthened, additional clinical staff have been appointed and staff training, hospital culture and communications have improved.

The Dublin Midlands hospital group has been working for some time on a draft plan for a new model of clinical service delivery at Portlaoise hospital. A draft plan was submitted to the Department of Health in December 2016. This draft report was reviewed in detail and was the subject of engagement between Department officials and the HSE. Significant additional work was undertaken by the HSE on foot of this engagement, resulting in a revised draft plan that was submitted to the Department in September 2017. I emphasise again that patient and public requirements are paramount and have underpinned the Department's consideration of the draft plan.

The report is currently under detailed consideration in the Department of Health. Once there is an agreed position on the draft plan, it is intended there will be further engagement with all interested parties to ensure the needs of patients, staff and the local and wider community are addressed. Any future changes to services at Portlaoise must take account of existing patient flows and demands in other hospitals, as well as the need to develop particular services at Portlaoise in the context of the overall service configuration in the Dublin Midlands hospital group.

Everybody in Laois and in this House would accept and agree that patient safety is the most important aspect of the services in Portlaoise but this plan does not achieve that goal. In 2014, the Health Information and Quality Authority, HIQA, produced a report at the request of the Minister and a second report was issued in December 2016. I will quote the statement of Dr. O'Reilly from two days ago. She states, "Specifically, in December 2016 HIQA again highlighted significant patient risk at the hospital and found that the governance arrangement in the emergency department remained largely unchanged" from 2014. Who was the regional manager from 2014 to 2016 who did nothing? In 2015, she announced the scaling down of the accident and emergency department, which did more than anything to undermine public and staff confidence. It put people off coming to take up positions in Portlaoise. Her actions before she put pen to paper to draft a report undermined the accident and emergency department. People said it was not a place to go to further one's career. That act did more to damage patient safety in Portlaoise hospital than any other action by any other person. She has done more damage than good to Portlaoise hospital.

She should have spent those two years upgrading the accident and emergency department, as was done in the maternity section. HIQA found problems in the maternity area and there are now management arrangements with the Coombe, as well as extra resources and staff. The same is required in the accident and emergency department but she chose not to act. As a result, we are where we are. Looking at the national context of the report, one can see we need positive leadership for the region and somebody who will approach the matter positively so as to build services. Who would ever speak about closing hospital services, as proposed in the document, with 680,000 people on waiting lists? There is also talk of investment in the Coombe but the Government has already made the decision to close the Coombe hospital and move it to the St. James's Hospital site after the national paediatric hospital is built.

I ask the Minister to meet Members now rather than after a decision is made. Dr. O'Reilly wrote to me last week asking to meet and I will do that next Tuesday to discuss the matter.

The decision regarding retention of the accident and emergency department at Portlaoise hospital is in the hands of the Minister for Health, Deputy Harris, who should be leading by example. The approval of the proposed action plan submitted to the Department of Health is a policy decision for the Minister, so I urge him to take immediate action. It has been stated that lessons have been learned from other downgrades but has the Minister learned any lessons? More important, have such lessons been taken on board? The Minister should be able to make a commitment as soon as possible that there will be no downgrading at Portlaoise hospital and he should seek to reassure people who are, at this time, very concerned about the possibility of a reckless and short-sighted decision being taken. Such recklessness will put the lives of many patients at serious risk. For example, we can look at attendance at the accident and emergency department at Portlaoise, which should be taken into consideration. In 2016, there were a reported 39,212 visits to the department. This demonstrates that the department is very busy and there is a need for extra resources. The emergency department should be retained and I call on the Minister to make a commitment in this regard.

I thank the Minister of State for his response. I will focus on Naas General Hospital, which in some ways is inextricably linked with Portlaoise. Many of the people on the Kildare-Laois border have a decision to make as to whether attend at Portlaoise or Naas. The hospital at Naas serves all of Kildare and west Wicklow, as the Minister of State is aware, and it is under very significant demographic pressure. We have seen a major increase in our population in the past 20 years and the hospital now serves over 240,000 people. Last year the hospital saw a year-on-year increase in accident and emergency department attendance of 6.4%. That is purely because of demographics and it must be said that the management is doing a remarkable job in managing this increase. It is nonetheless at capacity.

We got funding to move 1,000 patients on a waiting list for endoscopy services. They were dealt with through the National Treatment Purchase Fund, NTPF. However, that still leaves 700 people on a waiting list for those services. We need the new endoscopy unit delivered for Naas General Hospital as soon as possible. Naas is under that type of pressure already. When we talk about the link with the services, what sets Naas apart from Portlaoise is that Naas does not have paediatric services. I have two young children and live in south Kildare. If there is an emergency situation, Portlaoise is the natural place to go. Tallaght is an awful long way to travel with a sick child. These are all causes of concern for residents of Laois and south Kildare. There is uncertainty in the ether. I want to see a very clear investment plan for the Midlands Regional Hospital Portlaoise to ensure that we deliver the services that are required in Laois and south Kildare and that those services are provided in a safe way in the best interests of everybody in that area.

The real issue here is a lack of resources and staff. There have been some improvements. The budget has gone from €44 million to €56 million this year. There have been improvements in the maternity services, which have almost a full complement of staff now, whereas before they were working with less than half the staff required. Portlaoise has always been on the back foot. Ms Susan O'Reilly wants to spend €100 million on a fantasy plan. If €10 million of that were given to Portlaoise, I guarantee that we would have a good, state-of-the-art, properly equipped hospital.

In reply to a parliamentary question I raised over a week ago, the Minister gave an answer similar to the one the Minister of State has just given. It seems as if the Minister is kicking the can down the road, because he said, "Once there is an agreed position on the draft plan, it is intended there will be a further engagement with all interested parties". The draft plan has been on the Minister's desk for the past year. Who is to agree that position?

We need certainty. The answer to the parliamentary question and the reply here today do not give us any certainty. We need confirmation of what is happening. People in Laois and the surrounding counties are entitled to answers to that. Reports on Laois are getting worse by the week. It is obvious what is coming. The Laois faculty of the Irish College of General Practitioners and Midoc have expressed a total lack of confidence in Susan O'Reilly. She is due to retire in early January. She will go, but the local community will still be there. The people will be there. This is her plan, but it is on the Minister's head as to whether it is signed off on.

The plan put forward by both the GPs and the Midoc staff mentions that, "it is recognised internationally that attempting to centralise high volume essential services produces risks for patients and does not achieve cost savings". They go on to say that it should be the bedrock of a system that is already low in terms of capacity. The Minister is here day after day. There is no capacity in the system. There has to be a regional network. I want the Minister of State to take that message back to the Minister for Health, Deputy Harris. There has to be a regional network of fully equipped emergency departments. Portlaoise is in the strategic location for that. I want the Minister to come back quickly on this matter, secure the future of the hospital and put Ms O'Reilly's plan through the shredder. She is retiring in the first week of January and she needs to take her plan with her. The copy that the Minister of State has should be put in the shredder.

My problem is that I am too lenient.

I assure all of the Deputies that I have taken note of all of their contributions and will relay them back to the Minister of Health, Deputy Harris, who is the line Minister with responsibility for this. Due to the competing demands on his time, he is not always able to come into the House. It is practice that Ministers of State from the Department would take some of these debates, but that does not mean that the Minister is any less-----

There is €100 million at stake here, not to mention lives.

The Minister of State should continue.

It does not mean that the Minister is any less interested or committed to the project. Deputy Stanley is correct to say that it is not about resources. The resources to the hospital have improved under this Government by €12.5 million over the past three or four years, which is a significant increase in investment in any hospital the size of Portlaoise over that time. Nobody has a monopoly on the right thing to do. I welcome the debate in the House and the opportunity for public representatives to have their say. Our duty, as public representatives, is to feed into this process, and we have to have the voices of local people heard in our hospitals because they are the owners. Other voices have to be listened to, which voices have as much if not more expertise in different areas which affect the future of hospitals. I am referring to clinicians and people who practice, and also, of course, to the management of the HSE and departmental officials. Public representatives are a vital cog in that as well. I welcome the opportunity to air the debate here.

The draft report that we referred to was revised and resubmitted back in September after further consultation. There was a commitment that there would be an update on that report in the coming weeks. The Minister for Health, Deputy Harris, will give us an update on that revised report.