Dáil Éireann díospóireacht -
Thursday, 22 Nov 2018

Vol. 975 No. 4

Ceisteanna ó Cheannairí - Leaders' Questions

Deputy Dara Calleary

Many of us have been members of Scouting Ireland during the years and there is no doubt that the leaders and volunteers in that organisation do fantastic work in communities across the country. However, the revelations dating from last January of complaints of sexual assault made by a woman in 2009, when she was 18 years old, have opened up a new insidious and grotesque litany of sexual abuse cases over many decades in the scouting movement. The abuse occurred mostly when children were on trips. Scouting Ireland's handling of the initial allegation was, in the words of Mr. Ian Elliott, one of the experts in this area, deeply flawed. The initial allegation has been followed by a full review of historical cases which found that there were 71 alleged abusers and 108 victims between the 1960s and 1980s alone and that there were also incidents in more recent times. We must remember not to focus on the numbers but rather on the fact that each one represents a person or a family who has been affected. Mr. Elliott confirmed all of this to the Minister for Children and Youth Affairs, Deputy Zappone, and the Oireachtas Joint Committee on Children and Youth Affairs yesterday. He also said the work was incomplete and that the numbers were likely to rise. Everyone in this House agrees that this is reprehensible and the sooner we can get the full facts the better. One in Four, a group with expertise in this area, has described the figures as astonishing.

A huge number of people are affected. They were much younger when they suffered the abuse and may not have come forward with their story and are holding on to what happened to them. They have held on to it for many years. Mr. Elliot outlined how 14 of the alleged perpetrators had multiple victims. He discovered that there was one serious perpetrator, of whom Scouting Ireland had no knowledge and on whom there was no file. There have been many enforced changes to Scouting Ireland since the initial inquiry. We hope the initial Government arrangements are robust enough to ensure any further allegation of abuse will be reported under the current legislation and that those who make reports under it will be given the support they need. Families and the children involved want this to happen to allow them to have security and their voices to be heard in this debate. It will also help them to come forward.

Given the seriousness of this issue, is the Minister satisfied with the process involved, how the allegations were examined and that known victims have access to full counselling services and any other support they require? What processes is the Government putting in place to allow people to come forward who might not otherwise come forward and are they being allowed to do so on a confidential basis? Has the Minister, Deputy Zappone, met him to ensure An Garda Síochána will be involved at every level to assist and support victims? Will the Government give consideration to the establishment of a specific helpline to allow people to come forward in confidence and provide the security and help they need?

Minister for Justice and Equality (Deputy Charles Flanagan)

I thank the Deputy for raising this most important matter, notwithstanding the fact that it was the subject of a discussion at a Oireachtas joint committee as recently as yesterday. Like all Members of the House, I am appalled by the allegations of historical abuse that have emerged at Scouting Ireland. As my colleague, the Minister for Children and Youth Affairs, Deputy Zappone, said, Scouting Ireland informed her office late on Tuesday that, as part of a review being carried out by Mr. Ian Elliott, evidence had been found of 71 alleged abusers and 108 alleged victims to date. Scouting Ireland has advised that most of the cases relate to the period between the 1960s and the 1980s. It has advised that some of the alleged victims and abusers became known to it separate from the examination of historical files. Several victims have come forward recently, as the Deputy acknowledged. The Minister has further been advised that none of the alleged abusers is still working with Scouting Ireland. It has been confirmed that reports have been made to Tusla, An Garda Síochána and other police forces in jurisdictions in which many of the alleged abusers are in residence. I acknowledge that in recent times the Minister reinstated funding for Scouting Ireland for a period of six months, until April next year. Like her, other Ministers and I are extremely concerned about the very high number of alleged cases of abuse. In that regard, the Minister is seeking additional information from Scouting Ireland. Funding has been restored on an interim basis only and the matter remains under examination.

Every support will be made available to the victims to ensure they can and will come forward and that they will be assisted in that pursuit. The appropriate authorities will engage in the necessary investigative work.

Deputy Dara Calleary

I welcome the assurance given that none of the alleged abusers is still working with Scouting Ireland. That is important. Is the Minister confident that Scouting Ireland has the capability and the resources to manage the situation? It is really important that we receive the information and the facts as soon as possible. The drip-drip of information has to stop in order that we can build confidence within scouting and the agencies involved in it in order that those who have not come forward will be able to tell their story and access justice. It is important that we look at the establishment of a helpline. The Minister for Children and Youth Affairs, Deputy Zappone, said she was seeking to meet the board of Scouting Ireland. Has that meeting been arranged and, if so, when will it be held? Will the Minister confirm that Tusla will become involved and provide the backup support necessary to ensure the most important people in this - the victims - will be allowed to tell their story and access a path to justice without an inordinate delay?

Deputy Charles Flanagan

The Government and all appropriate State agencies will make every effort to ensure this issue will be fully investigated and that all victims can come forward in a timely and appropriate manner. I acknowledge the new board of Scouting Ireland and the review of the governance of that body which was carried out in May. The Minister for Children and Youth Affairs, Deputy Zappone, appointed Ms Jillian van Turnhout as an independent expert to examine the governance structures in Scouting Ireland and related issues. Ms van Turnhout submitted her final report on 14 June. The board confirmed its decision to implement fully all of the recommendations made related to governance.

It was on that basis that the Minister, Deputy Zappone, sanctioned funding for an interim period of three months until the end of September, at the end of which the then board voted to reinstate the chief scout as chairperson. This was done, notwithstanding the fact that the chief scout was a respondent in an ongoing independent barrister's investigation. This, of course, was unacceptable to the Government. I welcome the appointment of the new board. We must ensure every effort is made to bring this matter to a satisfactory conclusion for the victims involved and that there is due process in the context of any investigation, including Garda investigations. My Department will assist other Departments and State agencies, as appropriate.

Deputy Pearse Doherty

I refer to the ongoing crisis in child and adolescent mental health services, CAMHS, across the State. Everyone here knows parents and families who are struggling to access care for their children. We have all heard from staff acting on the front line who find that drastically inadequate staffing levels make it impossible to meet the demand for the care they want to provide. Figures provided by the HSE for my colleague, Teachta Louise O'Reilly, show that midway through the year the waiting list for CAMHS stood at more than 2,700 children and young adults. That is not the waiting list for treatment but for the very first step of initial assessment. Many young people have been waiting a year or more to be assessed. These are the young lives that are in limbo. There are families who are at their wit's end. The State is failing children.

In some parts of the State the waiting lists are absolutely shocking. In the area covered by community healthcare organisation, CHO, 1 which includes my constituency of Donegal there was a waiting list of 203 children at the end of last year. In the area covered by CHO 4 which includes counties Cork and Kerry there was a waiting list of 737 children for an initial assessment for mental health services. It is an absolute scandal. We cannot continue to allow these lists to grow and grow putting more children at risk. That is what it all boils down to. Children are at risk because the State is failing to make sure the care for which they are reaching can be provided.

CAMHS simply is not meeting the needs of young people who are often in desperate need of immediate care. It is primarily the result of a failure to recruit the staff needed to fully operate CAMHS teams. For some time about half the positions in CAMHS teams have been vacant across the State, yet when my party leader, Deputy McDonald, raised the issue of the recruitment and retention of nurses, including psychiatric nurses, the Taoiseach simply dismissed our concerns. An immediate response is needed, particularly in areas where the problem is at its worst. Earlier this year the Oireachtas Joint Committee on the Future of Mental Health Care outlined a raft of measures to improve the recruitment and retention of vital staff. By filling vacancies quickly and improving conditions we can improve services, attract more staff and keep the excellent staff we already have. Let me state that when CAMHS is able to assess and care for young people, the service does an excellent job, with very good results. However, we cannot allow a situation to persist where if a child or a young person needs care, he or she faces an extended period of waiting that will put him or her and his or her mental health at serious risk. We need to see dedicated action to attract new staff and keep the excellent staff we already have. Promises were made by the Government last year that the disastrous staffing levels in CAMHS would be addressed, but they have not been. Will the Government recommit to doing so and ensure it will actually happen this time?

Deputy Charles Flanagan

The answer to the Deputy's question is "Yes". We will ensure every effort is made to deal with the issue, which I acknowledge is a challenge. I acknowledge the importance of the issues raised by the Deputy. Improving all aspects of CAMHS nationally is a priority for the Government and the Minister of State, Deputy Jim Daly, in particular. An additional €84 million will be provided for mental health services in 2019, which will bring the total available for mental health services to €1 billion, which represents an increase of 9%. That, however, is not the whole issue. I acknowledge what the Deputy has said about staffing and the recruitment challenges. I also acknowledge that there is a difficulty not only in recruitment but also in retention. That applies across the health system but particularly in the mental health service. Every effort is being made by the HSE to address the issue.

I note that primary care capacity has been further developed recently through the funding of a further 114 assistant psychologists and 20 senior psychologists. This will help to manage the demand for psychiatric services, but I acknowledge that it is more than just that. There is also an issue in meeting the demand for psychiatric and psychological services. The HSE and other agencies are working closely with appropriate recruitment agencies, not only in this jurisdiction but also on the international stage, to find suitable and appropriate consultant psychiatrists to deal with this issue. One the one hand, we have increased the resources and, on the other, it is important that every effort be made to attract a proper and adequate coterie of individuals to deal with what is a very serious problem across society.

Deputy Pearse Doherty

I have listened to what the Minister has said. I could go into detail, distilling the figures and examining how much was spent on agencies and how much was pre-committed in 2017. However, the reality is that parents listening to this interaction will not take any comfort from what the Minister has said. I know some of them personally, as I am sure the Minister does, too. They tell me that they phone the service on a weekly and sometimes daily basis, that they are in tears, pleading, demanding, asking and begging for their child to gain access to a service in order that he or she can have a diagnosis and receive the wraparound supports he or she needs. They are telling healthcare professionals that they are worried about their child's mental health. They are worried because their child who is sometimes as young as eight, nine or ten years old is self-harming or could take more drastic action. We have heard these commitments given by the Government before. Last year the waiting lists grew longer. The number of children waiting to be seen has grown and the time they have to wait has lengthened. There is a failure in government. This is a microcosm of how the Government is failing to plan to fulfil the health needs of our society. Every single party represented in this House supports full implementation of A Vision for Change. It is included in the programme for Government. When will we be able to come into the House and say this objective will be realised? When will we be able say to the 2,700 children waiting and their parents that their mental health needs will be met by the State? This is not cherishing the children of the nation. It is cruelty and neglect of children and it is happening on the Minister's watch. The Government has been in office for eight years. It must take some, if not much, of the responsibility on its shoulders and act now.

Deputy Pat Buckley

Hear, hear.

Deputy Charles Flanagan

Deputy Pearse Doherty is not the only one who engages with parents and constituents on this issue.

Deputy Seán Crowe

That is what he said.

Deputy Charles Flanagan

I do so on a regular basis in my constituency engagements, as do all of my colleagues on this side of the House. I acknowledge the importance of the issues raised and a determination on the part of the Government to deal with the matter in a satisfactory way. I also acknowledge the dedicated and designated functions of the Minister of State with particular responsibility for this area, Deputy Jim Daly. I repeat that there has been an increase in total funding to the tune of almost €1 billion for mental health services next year. There is an additional allocation in excess of €50 million for new mental health service developments.

If the Deputy requires a drilling down into the figures, as he mentioned, I assure him that €35 million of this will be apportioned for new developments, while a further €20 million is for growth projects which commenced this year.

The focus for funding for next year will be on early intervention. Deputy Pearse Doherty is correct in this regard. The importance of early intervention is well known and accepted. A further focus will be on support services which will assist people in dealing with mental health challenges before they may require acute psychiatric care.

I acknowledge the challenge in respect of the recruitment and retention of staff. The Minister of State, Deputy Jim Daly, is taking an active approach and making every effort to address this matter. He is also in discussions with local managers of HSE regions to deal with the unacceptable level of waiting lists, an issue raised by Deputy Doherty.

Deputy Bríd Smith

I have a series of questions about what is really going on with the back door to this place in terms of Irish Water. On 16 November, staff who were seconded to Irish Water from local authorities received a letter from Irish Water management stating that the service level agreement under which they work, which is due to expire in 2025, will be renegotiated and all negotiations concluded by the end of February 2019. This is the result of a report commissioned by the Minister for Housing, Planning and Local Government, Deputy Eoghan Murphy, in May 2018 when he asked the Workplace Relations Commission to review the service level agreement, consult all sides and produce a report on the matter. The report was submitted to the Minister in September. All of the bodies that contributed to the report, namely, the Local Government Management Agency, the relevant trade union, the Workplace Relations Commission and the Irish Water utility, acknowledged that the arrangement of seconding to Irish Water workers who had spent their working lives employed in local authority water services has been brilliant. The experience, skills and depth of knowledge they brought to Irish Water was found to be indispensable and very much welcomed by the utility. When one reads the report, one finds that all the relevant bodies share this view.

The problem is that the Minister for Housing, Planning and Local Government is rushing to change the service level agreement, which is supposed to last until 2025. He wants to change it in 2021 and wants the negotiations on same ended by February 2019, which is three months away. I have noted the co-ordination in this campaign. The report was published in September and shortly afterwards, a report is published setting out excess charges that will be implemented in 2020 and how much income they will generate. Shortly after that, the Environmental Protection Agency produced a report showing that local private water utilities are poisoning people because they are not delivering a proper service. We then get reports that the Government proposes to undermine a Bill introduced by Deputy Joan Collins and supported by many parties providing for a referendum to prohibit the privatisation of Irish Water. It will do so by amending the Bill to allow for an element of privatisation known as public private partnership, PPP. What will happen to the jobs of Irish Water workers who do not want to transfer to a utility that may privatise water in the future? Will the Government get over itself and, once and for all, tell people that water will remain in public hands and will never be privatised? It must make that clear because the messages are extremely confusing and extraordinarily worrying for communities and, in particular, the workers in question.

Deputy Charles Flanagan

I thank Deputy Bríd Smith for her strong support of Irish Water.

Deputy Richard Boyd Barrett

That is not what the Deputy said.

Deputy Charles Flanagan

It is the first time that I have heard it and I welcome it. I admit that I have not read the report to which she referred, nor have I seen it. I am not, therefore, in a position to offer any commentary on it. I would be pleased to make early contact with my colleague, the Minister for Housing, Planning and Local Government, Deputy Eoghan Murphy, to address the three questions that the Deputy put to me.

It is important, within the timeframe suggested by the Deputy, that there is a form of consultation and dialogue and every effort is made on the part of management to ensure that worker and staff concerns, such as those outlined by the Deputy, can be addressed. We also have the industrial relations mechanisms of the State. I hope that over the next few months the grievances, as identified by Deputy Smith, can be dealt with through discussion, dialogue and consultation.

I very much welcome the Deputy's support for Irish Water and her commentary on the matter of the workforce. I assure her that every effort will be made by the Minister to ensure an appropriate transition.

Deputy Bríd Smith

To correct the record, I never once said I support Irish Water. I will clarify my position for the Minister. The reason I am on my feet is that I fully support the staff who were seconded from the local authorities to work for Irish Water. I take my hat off to them and to their expertise, skill and commitment as well as their ability to deal with problems at a local level with which they are so familiar because they have spent years working on water services. We treat those workers badly or diss them at our peril.

The Minister stated there is a form of consultation and dialogue taking place. It is shoving this down the throats of workers to have a complex service level agreement renegotiated within three months when they only heard about it last week. That is not dialogue or consultation. There needs to be an absolute guarantee in respect of their conditions, pensions, work and who they work for. Do they work for the public service or will they work for some PPP entity called Irish Water in future? The Minister did not comment on the privatised, back-door nature of what the Government is attempting to do here.

Shame on the Government that its members have not been informed of the report. The Minister, who has an adviser seated beside him, should read the report. It states that the workers who have been seconded to Irish Water are an invaluable asset to this project. We will try to mess them about or take away their terms and conditions at our peril. Will the Minister comment on the issue of privatisation by the back door?

Deputy Charles Flanagan

I assure Deputy Smith that there is no back door process or secret arrangement under way. Any discussions of an important nature will take place in the course of due process. There will be an adequate consultation process. There is a timeframe, as mentioned by the Deputy, within which all of the arrangements can be managed if there is the will on the part of everybody involved.

Deputy Bríd Smith

That is not a timeframe.

Deputy Charles Flanagan

I, too, acknowledge the hard work that has been undertaken by Irish Water workers engaging in what is a vital public service. I also acknowledge the challenges being undertaken by Irish Water in recent times in view of the changes by way of legislation introduced in the House. We still have a great challenge to ensure that our water services are improving in accordance with our commitments given in the programme for Government.

Deputy Bríd Smith

The Government must look after the workers if it wants to meet that challenge.

Deputy Charles Flanagan

There is also a long-term need to ensure a proper and adequate water supply of world-class standard in our Project Ireland 2040 proposals.

I encourage Deputy Smith to continue to engage. I assure her and other Deputies of the active engagement on the part of the Minister and his officials.

Deputy Noel Grealish

There is a serious problem in hospitals all over the country, with beds being occupied by people who are well enough to be discharged but have nowhere to go. At the heart of the problem is the time it takes to get approval for nursing home support under the fair deal scheme and the growing numbers of people waiting for approval for home help under the home support service.

The knock-on effect of this is that people on the waiting list for operations and other procedures cannot get into hospitals because there are no beds available for them. In many cases, it has taken several weeks for applications for the fair deal scheme to be approved. There are people occupying hospital beds who have recovered sufficiently to be discharged but who cannot manage on their own at home. Pending approval of their application, they are expected to pay €900 or more per week to stay in a nursing home, money that they often simply do not have, so they must be kept in hospital until approval comes through. It is not where they want to be. It is widely accepted that people need to get out of hospital as early as possible to avoid the risk of infection. There are many others who could go home if they had sufficient support in the form of home care services but, unfortunately, there are long waiting lists for home help in many areas. The most recent figure concerning the number of people awaiting approval for home help is more than 6,200. My home county of Galway has the worst record in the country with more than 670 people waiting for home help.

Thankfully, our population is living longer but that also means that the demand for home help services and nursing home care will continue to grow. Unless sufficient resources are allocated to meeting this demand, the problem of hospital beds not being freed up will also continue to grow. This in turn will lead to growing numbers of people on waiting lists for treatment waiting for beds to become available and growing numbers spending nights on trolleys in our emergency departments because they also cannot be moved to a bed in the hospital.

I acknowledge that some progress has been made this year regarding the number of people on waiting lists for inpatient or day case treatment. However, more than 72,000 people were on waiting lists for inpatient and day care treatment at the beginning of this month, almost 12,000 of which had been waiting a year or more. Galway University Hospital has the highest number of any hospital at almost 9,400. The same limited progress is not evident in respect of outpatient waiting list, which currently stands at more than 516,000 people. The total went over the half million mark for the first time at the end of last year and has remained above that extraordinary level every month of this year. Again, Galway has the highest number of people awaiting outpatient treatment at just under 40,000.

What further measures does the Government propose to take to ensure that people are released from hospital more quickly into the proper care they need and to ease the worry, stress and even physical risk to vulnerable members of our society?

Deputy Charles Flanagan

I thank Deputy Grealish not just for his question but also his expressed acknowledgement that progress is being made on this matter. I assure the Deputy and the House that the Government will continue to make progress on what is a particular challenge. It is a challenge that faces us as we come into the winter season. I assure the House and Deputy Grealish that the primary focus of Government is on reducing delayed patient discharges. We can do this through the mobilisation of additional resources. As the Deputy acknowledged, the aim is to ensure that social care measures are effectively deployed, which will have the effect of enabling older people to leave hospital and return to a more appropriate care setting, including primarily their own home, as quickly as possible. If they are returning to their home, they will need adequate supports.

I assure the House that as part of its preparation for winter, the HSE has been requested by the Minister for Health to focus efforts on initiatives to enable hospital settings to de-escalate before the Christmas period, including supports of a social care nature. The HSE has commenced a range of measures to support older people's transition from acute care before Christmas into the new year. These measures were welcomed yesterday by the Minister for Health and the Minister of State with responsibility for older people, Deputy Jim Daly. This includes an allocation of 550 additional home care packages over the winter period. This is one of a number of initiatives that include additional transitional care beds and €4 million for aids and appliances that will assist older people to come home from hospital before Christmas and remain in their homes over the new year or for longer periods.

The importance of transitional care must not be understated. If it is appropriate, it is arranged through utilising the patient and family choice of provider. The use of transitional care has proven to very valuable in the hospital system. It has benefited and continues to benefit the transfer of large numbers of patients to more appropriate settings. Information of a preliminary nature, which I am happy to share with Deputy Grealish and others, will show that there have been more than 9,800 approvals for funding to date this year of which 830 were in Galway University Hospital. I assure the Deputy that the Department of Health expects the details of the winter plan to be finalised over the coming days. It will be published later this month and I am sure the Minister of State, Deputy Jim Daly, along with the Minister, will continue to keep the House and Deputy Grealish fully informed of developments in this challenge.

Deputy Noel Grealish

I am aware that there are many and often complex reasons for thousands of patients occupying hospital beds for longer than is ideal every year. I am familiar with many of these cases. The fact remains that the delays in approving fair deal applications for nursing home care and delays in funding for home care packages create some of these hold-ups. As I mentioned earlier, a hospital is the last place one would want older family members to be in if it is not necessary. International research has shown that every extra day in hospital increases the risk of acquiring an infection, having an adverse drug reaction or developing problems like bed sores. New Irish research published in the British Medical Journal found that older people were 72% more likely to be given prescriptions that were not appropriate for them.

I call on the Government to speed up the application process for the fair deal scheme. This would free up hospital beds and get people out of hospitals. There is a significant delay in approving home care packages. I welcome the announcement made by the Minister, but bringing a loved one home when there is no care at home for them is a significant worry for families. Will the Minister give a commitment that the Government will speed up home care packages and the application process for the fair deal scheme?

Deputy Charles Flanagan

The announcement yesterday of 550 extra home care packages is proof of the determination on the part of the Minister of State, Deputy Jim Daly, and the Minister to ensure this issue is adequately dealt with. I am assured that these initiatives will provide older people with the type of care they need, which is the type of care requested by Deputy Grealish. I am very keen to ensure it is delivered in the right place and within an appropriate period of time. Older people wish to be supported in their homes and in their communities. The additional investment in social and community care measures will support this objective in the winter ahead. The net budget for the nursing homes support is in excess of €960 million. The scheme supports approximately 23,300 people in respect of long-term residential care. The waiting time for funding approval is three to four weeks, but I assure Deputy Grealish that the Minister of State with responsibility for older people, Deputy Jim Daly, is focusing this winter on the issue of delayed discharges and social care measures, including the investment in home support, which will assist people in returning home to their communities as quickly as possible.