Ceisteanna ó Cheannairí - Leaders' Questions

I wish to raise with the Minister the comments made by An Tánaiste, Deputy Varadkar, yesterday, when he lectured the families of Donegal and the west of Ireland whose homes have been devastated by mica and pyrite. These families have campaigned long and hard for this Government to do what is fair and deliver 100% redress. The Tánaiste lectured those families, who are going through hell, about the burden that a fair and just scheme would place on taxpayers. He included a smart alec quip about it not being the Government's money. How dare he? The Tánaiste never gave such lectures to the families in Dublin and north Leinster who rightly and justly received 100% redress when their homes were severely impacted by pyrite.

The families in the west of Ireland have been treated like second-class citizens. They have been denied a fully-funded 100% redress scheme. This is completely unacceptable and leaves families who have done nothing wrong with massive bills that they cannot afford to pay. Such glib comments, attempting to turn public opinion, have a devastating impact on these families. It creates an anxiety and a fear that those leading this Government do not hear them and will not do the right thing. Minister, you have to do the right thing. We are talking about people whose homes are literally crumbling around them. These are families who worked hard, paid their taxes and saved hard to buy their homes. Now, through no fault of their own, they find themselves in a horrific situation where their houses are cracking and coming asunder around them.

The human toll of this ordeal has been heartbreaking. This has led to unbearable mental distress for families. I know families and people who have been close to emotional breakdown. These people are close to financial ruin. They say that their very lives have crumbled around them with their homes. For them, the dream has turned into a living nightmare. I live in Buncrana, the epicentre of this disaster in north Donegal. This scandal has left deep scars on our community. It is agonising to see neighbours, friends and family suffer in this way.

I do not think I have the words to convey to the Minister the trauma these families are going through, but I need him to listen to me here and now. This needs to be brought to an end. The families have made their final submission to the working group. The Minister must surely know the key asks the campaigners and families have made. The Government cannot keep standing idly by. The families demand a scheme that covers the full cost of rebuilding their homes. That is right and just. As Minister for Public Expenditure and Reform, the Minister has the power to bring incredible positive change to the lives of families who have been through this living hell. I am asking him on behalf of those families to do the right thing. Will he tell them today that the Government will deliver 100% redress?

I thank the Deputy for raising this issue. There is a deep appreciation within the Government of how serious this issue is and the life-changing nature of this issue for the families who are affected by mica in Donegal, Mayo and a number of other counties where the issue has now emerged. That is why the Government has put in place a process to try to bring about a resolution to this matter. I have listened to the heartfelt stories from the families who have impacted upon. I can only imagine what they are going through and the worry they are having to carry every single day. The main point I want to make is that everything is on the table. The Government has ruled out nothing in the context of what will be needed to support those families. As the Deputy is aware, a scheme is up and running, which was broadly welcomed when the details were announced in January of last year. The scheme opened for applications in June of last year and a significant number of applications have come in. However, the shortcomings of that scheme have also been highlighted. It is important to acknowledge that the scheme was put in place in good faith by the previous Government and was a genuine effort to address an issue which is so important for many thousands of families.

The work of the working group that was set up by the Minister for Housing, Local Government and Heritage, Deputy Darragh O'Brien, is ongoing. As the Deputy rightly stated, the families impacted have made a submission as of last Friday to that working group. Earlier in the summer there was a request by the impacted householders for the work of the working group to be extended until the end of September, and that was agreed by the Minister. That is the timeline we are working to. The working group will now consider the submission from the householders who were affected and the Minister intends to accept the report from the working group by the end of this month, which essentially is at a point next week. He will then consider that, discuss it across Government and come to a view as to what we can do quickly to support those families. I, my Department and the whole of Government stand ready to assist in every way we can.

This is an issue the Minister for Agriculture, Food and the Marine, Deputy McConalogue, has raised on many occasions at Cabinet and the Deputies from within the Government parties from the affected counties have been raising it consistently as well. I acknowledge that Deputy Mac Lochlainn and his colleagues have done the same. We are all on the same side here. We want to get an outcome that works for the householders who have been affected. To date, there has been an exemption for them from the local property tax, which is a very small measure, but it is an important symbol and a statement of support from the Government. Last night in the House, the Minister for Finance, Deputy Donohoe, gave a commitment that he will take up the issue with the banks to see what role they can play in supporting an overall resolution to this problem. Issues such as rent, storage costs and so on, which have been raised by all the families, are all on the table. We have a process in place. We are not standing idly by. We are committed to working with the impacted householders to address this. Of course, we need to have checks and balances and certain controls in place. I do not believe people should be passing judgment in advance as to the nature of those before hearing what the Government has to say. We have to come to a considered view once we have all the information on the table. I expect we will have that very shortly. We look forward to bringing forward a proposal that I expect will represent a significant enhancement of and improvement to the existing scheme for the impacted householders.

Last night, the families presented their submission to Deputies and Senators across the country. They have clearly demonstrated the solutions that will be required to turn around so many people's lives. Those families should not have had to do all that work. Families should not have to protest or bare their hearts and souls and take journalists from up and down the country to their homes. None of that should have been required. I hope the Tánaiste will take back what he said yesterday because it was completely wrong. The Minister for Agriculture, Food and the Marine is from Inishowen, which is also at the epicentre of this. He is a Fianna Fáil Minister, as are the Ministers for Public Expenditure and Reform, and Housing, Local Government and Heritage and, of course, the Taoiseach, Deputy Micheál Martin.

Collectively, they have the power to change what has been a nightmare into a moment of great hope in the weeks ahead. I appeal to the Minister to fully endorse that submission and deliver the change our families need along the west of Ireland.

I wish to reiterate that we are attaching the appropriate level of importance to this. We recognise the devastating consequences of living with mica, which too many families are experiencing at this time. This working group is chaired by the Secretary General of the Department of Housing, Local Government and Heritage. Once we have a completed working group report, my officials and I will stand ready to engage intensively to bring about a Government statement and decision, with the support of the Cabinet, on the next steps. This should not be a political football. We all want to support the families who have been impacted. The Deputy gave a broad welcome to the current scheme that was put in place at the beginning of last year. His party did not mention mica in its manifesto in the general election last year. Let us be straight and work together to bring about a resolution for the people we represent. That is what this Government is focused on. I believe the Deputy would expect us to make sure we have a full handle on the overall picture and to make a proper assessment of what exactly is at play. That work is being done and I expect to have the report next week. The Government will then act decisively and bring forward its proposals.

In a couple of weeks' time, the Minister will come into this Chamber to announce his budget proposals. It is highly likely the Department of Health will again be awarded record levels of funding, potentially in the region of €22 billion. Given the crisis caused by Covid and the more than 900,000 people now on hospital waiting lists, this level of funding is undoubtedly required. The Social Democrats will support that funding commitment if and when it comes. However, the Social Democrats differ from the Government in one important matter when it comes to the health service, namely, we do not believe in repeatedly pumping large amounts of public money into a dysfunctional health system. Money alone will not solve the endemic problems in our broken health service. In tandem with the spending commitments, we need to see urgent reform in order that everyone who needs access to healthcare receives timely care and has the best possible outcome.

The blueprint for that reform - Sláintecare - was agreed on a cross-party basis in 2017. The Government has the plans, yet it refuses to implement them. It seems the Government is not interested in reform. All it does it pay lip service to it. The Minister does not have to take my word for that. He can listen to the two senior Sláintecare managers, Laura Magahy and Tom Keane, and the former chair of the South/South West Hospital Group, Professor Geraldine McCarthy, all of whom have now resigned. They will tell him that serious institutional resistance to essential Sláintecare reform is threatening the entire project. We know where that resistance is emanating from, namely, the HSE and the Department of Health. Critically, there is also a lack of political leadership, a lack of commitment and a lack of courage at the top from the Minster for Health and the rest of the Cabinet. We will never see reform of the health service unless the political will is there to drive it in order to take on the vested interests, wherever they come from, and to ensure that the people of this country have access to healthcare based on need and not ability to pay. More than a decade ago, Professor Keane had staunch support from the then Minister for Health, Mary Harney, when he reformed our cancer services. It was a hugely controversial reform at the time. He would not have been able to do it otherwise. If the same level of political support existed today for the Sláintecare reform, would Professor Keane have resigned? The answer to that question is obvious.

I have three questions for the Minister. How does he expect the people to have confidence in the Government's management of Sláintecare when so many key people do not? Why is the Government refusing to acknowledge the serious problems that exist with the Sláintecare implementation? Is the Minister going to reappoint the members of the Sláintecare implementation advisory council, which has only eight days left in its term of office? As of yet, they have received no engagement from the Department of Health on their future.

I thank the Deputy for raising the issue of Sláintecare and the Government's commitment to the reform of our public health service. I reassure the Deputy, the House and the Irish people that the Government remains absolutely committed to fundamental reform of our health service. We are committed to the implementation of Sláintecare, which was not a one-year or a two-year plan; it was a ten-year plan.

In making the decision last year to invest a record amount of funding into our health service, the Government made a step change in improving the capacity of our public health system with funding being provided including, for example, more than 1,000 beds to be added to our acute hospital system, a significant increase in our critical care beds, and the sanctioning of an increase in staff resources within the public health system for approximately 16,000 professionals, pre-Covid to the end of this year. There have been some delays in recruitment but several thousand additional staff are now working in the health service as a result of that investment.

We have provided more than 5 million hours of home care in the current year, 2021. Again, this was a significant increase. Discussions are under way in relation to a public-only consultant contract. This is an important reform in our health service. On the critical public health function, which everyone has a renewed appreciation of, we have approval for the first time in the history of this State for a consultant-led public health function in our country, including a doubling of resources across our public health teams. These are significant manifestations of the Government's commitment to Sláintecare backed up with real funding of approximately €1.25 billion in the budget last year for new measures. Additionally, in the recent implementation report on Sláintecare, some 97% of deliverables were either achieved or were on track. A small number were not and we acknowledge that.

The Deputy did not even mention the elephant in the room. We have had 18 months of living with Covid-19, a global pandemic that has turned our health service upside down. The Deputy did not believe it was even worthy of a mention. Our front-line healthcare staff have been trying to get by, protect lives and save people. That is what they have been focused on. Despite all that, we have brought about significant and transformative change in our health system during that time by way of the investment made in the public health service. We are committed to working towards universal access, free at the point of delivery, in our health and social care system. We made a decisive step in that direct in budget 2021. I am now in discussion with the Minister, Deputy Stephen Donnelly, as part of the Estimates process for the upcoming budget.

Sláintecare is an incremental ten-year programme. It is supposed to start in year 1 and build every year from then. It seems the Minister is joining his Cabinet colleagues, in particular, the Minster for Health, in downplaying the seriousness of the crisis that now exists with Sláintecare. He refused to engage in the fundamental problems, namely, the institutional resistance to the introduction of accountability for the provision of health services and accountability for the spending of that massive budget that is in excess of €20 billion. If he persists in refusing to acknowledge that elephant in the room, we will not make any progress in this.

The Taoiseach said he wanted to meet the two senior people from Sláintecare who resigned. That was 12 days ago. No further contact has been made since then. The Committee on Health wanted the Minster to come in and explain what was going on. We have to wait three weeks for that to happen. The advisory council members met the Minster and came out saying they were no wiser.

The Government needs to stop ignoring the elephant in the room.

Thank you, Deputy.

We must hear the truth in this matter and we must have political will and political leadership from the Government. If not, Sláintecare will not succeed.

Of course the Government acknowledges that the resignations were deeply disappointing. Of course we acknowledge that.

What are you doing about it?

We need, of course, to examine the reasons that those resignations took place. The Minister, Deputy Stephen Donnelly, has spoken directly to Laura Magahy and Professor Tom Keane. He has engaged directly with the Sláintecare implementation advisory council. He will, of course, go before the Oireachtas health committee. Yes, the Government is considering the structures that are in place and will consider the request for an extension of time by the implementation advisory council in that context. If there is a requirement to strengthen the governance structures and the arrangements we have in place for the delivery of Sláintecare, then of course we will do that. We are putting the money in place. There is absolutely no resistance within Government at a political level to delivering the reforms. This is what the people want. We have agreed, on an all-party basis, to implement it, and the Government is committed to doing so.

As another example and evidence of what we are doing, under our recent national recovery and resilience plan, we got support from the European Union in the form of €1 billion in funding, some of which will go towards a range of e-health projects, which is the future for health. We have seen the development and emergence of that over the course of the pandemic.

We move now to Deputy Tóibín of the Regional Group.

On 22 October 2019, the Tánaiste apologised for the humiliation, disrespect and deceit shown by the State to the more than 1,000 women in the cervical cancer scandal. In May 2018, he stood up in this Chamber and made a promise to the women affected by the CervicalCheck controversy that they would not have to go to court in order to get justice. Patricia Carrick from Galway sadly passed away last year, only a month after she won her case in the courts. Patricia was one of many women who had to battle in the courts for justice, often suffering from great ill health, right up to the point of losing their lives. The Taoiseach stood up in the House and apologised to Patricia on behalf of the State.

Statistics released to me this week by the State Claims Agency show that since those apologies and promises that no woman would be forced to go through court, a total of 310 women or families have been, in fact, forced to go through the courts or take legal routes to achieve justice. Tragically, 38 of those claims relate to women who have already died. A total of 77 cases have been lodged this year alone. Meanwhile, the CervicalCheck tribunal, which was established by the Minister, Deputy Stephen Donnelly, has so far received eight claims. We all know what happened with the tribunal. The Minister ploughed ahead with it, ignoring the advice of the 221+ group. He disregarded the concerns and did not listen appropriately to the women affected. In an obvious attempt to attract more claims, the Government extended, by way of legislation before the recess, the time period by which women could make claims to the tribunal.

We are all too familiar with how cruel the court experience is for these women, with the State fighting them for months and years and, in some cases, only settling when it becomes apparent the women in question have only days to live. We are all too familiar with the names of the women. We are all too familiar with the frequent news reports featuring their images, often showing a young woman with young children, standing frailly but courageously outside a court. These women should not have to spend the last months of their lives on earth in a courtroom. They should be allowed to enjoy those months with their children and family. They should have the mental comfort and assurance that their children and family will be looked after when they are gone.

Regarding the tribunal, it is clear that women are voting with their feet. A total of 77 women this year have opted to go through the courts or legal routes. Only eight have opted to go through the tribunal. At this stage, will the Minister, Deputy Michael McGrath, not concede that the tribunal has failed abysmally?

I thank the Deputy for raising this very personal and sensitive issue. I personally know of a number of women and their families who have been impacted. I know the devastating impact it has had on their lives. The Government is here to support the women and their families. That is why we decided, with the full support of this House, to put in place a tribunal to support women to get justice without having to go through what can be the extraordinarily difficult process, in an adversarial environment, of going to a court of law. As the Deputy knows, the Government set up the tribunal on the recommendation of Mr. Justice Meenan and it is now enshrined in legislation.

I acknowledge the numbers the Deputy put on the record, which are undoubtedly very low. I think it is almost certainly the case that some women and their families are waiting to see how the process works out. If changes are required, then of course the Minister is open to any such changes to improve the system that is there. We do not want women to have to go to court to get justice on any matters relating to CervicalCheck. We can all agree in this House on the paramount importance of protecting this service, which is now back up and running. More than 6,000 women are detected and referred for early treatment each year. CervicalCheck continues to have very significant value for population health. In addition, we had the introduction last year of the HPV screening test, which is a very significant milestone for our cervical cancer screening programme.

The recent extension of the statutory deadline for making a claim to the tribunal will ensure that any woman or family eligible for the tribunal will have sufficient time to consider whether to make a claim. I know the extent of the contact and consultation the Minister, Deputy Stephen Donnelly, had on a personal level with the 221+ group and the issues it wanted to have addressed as part of the tribunal. The Government has done all it can at this point to support that process. We want a resolution that is non-adversarial in nature and that happens quickly. We acknowledge the real-time issues that are involved here. The Government will keep the matter under review. We want to see more of these cases settled in the tribunal than in the courts. However, we also have to acknowledge that it is the constitutional right of every woman to take a case to the court and to have it adjudicated in our judicial system, if that is what she so chooses. That option remains but we want as many cases as possible to be dealt with and settled through the tribunal.

The Minister for Health promised the 221+ group he would pause the process of the tribunal until there was an agreement reached on how it would work. That did not happen. In fact, the 221+ group found out in the media that it was going ahead. I raised the case of Patricia Carrick in the Dáil last year and, after I raised it, the clinical director of CervicalCheck wrote a letter to me that was critical of my speech. She said women had not been wronged and the slides had not been misread. I found this extremely odd because Patricia Carrick had won her case and received a State apology. It was clear these women had been wronged.

I then sought a meeting with CervicalCheck, at which I made this point to the clinical director. She replied, "The courts were wrong." There is complete confusion right now with regard to the Government's approach to these women. The courts and the Government are at odds with CervicalCheck and the HSE. We have a tribunal that is being avoided wholesale by the women. The Minister's words today, the apologies by the Tánaiste and the promises by the Taoiseach are in a completely opposite direction from what is happening with the women in reality. Will the Minister commit today to reform the tribunal, make it fit for purpose and finally fulfil the Government's promise to these women?

I want to make the point that the purpose of the tribunal is to get cases settled quickly, in months rather than years, and to respect the deeply sensitive, private and confidential nature of the issues at hand. The hearings are, of course, held in private. There are also pre-hearing steps designed to reduce the adversarial nature of claims, including allowing women to give written statements rather than verbal testimony. This is a much more informal process than going through the court system. We acknowledge the numbers the Deputy referenced.

They are being ignored wholesale.

The tribunal's rules of procedure enable it to make directions to progress urgent matters. The tribunal registrar has confirmed that urgent claims will be facilitated.

It remains the right of any woman or family to go to court. The Government wants to make the tribunal entirely user-friendly and the vehicle of choice for the settlement of these issues.

We recognise the right of women to go to court if that is their choice, but the Minister for Health, Deputy Stephen Donnelly, is continuing to keep the issue under review and if improvements can be made, he will bring forward the proposals.

Tá mé ag filleadh ar an cheist a d’ardaigh an Teachta Shortall maidir le Sláintecare. Is polasaí é a foilsíodh i mí Bhealtaine 2017 nuair a bhí an Tánaiste ina Thaoiseach ag an am. Bhí sé lárnach sa phróiseas. Is polasaí é atá teipthe ina iomláine ag an Rialtas go háirithe de réir fianaise na mbeirteanna sinsearacha a d’éirigh as a bpost le déanaí.

I am returning to the subject raised by Deputy Shortall. I read about it with disbelief. The resignations were shocking enough, but even more so was the manner in which the Government has dealt with them. The Minister, Deputy Michael McGrath, has come in here today and once again minimised the issue, putting the blame on Covid.

In addition to housing, health was the biggest issue for all of us in the past three elections, from 2011 onwards. In 2016, my group sent a member to the committee which worked on a cross-party basis to produce the Sláintecare report. Rather than come in and continuously complain and highlight deficiencies, which I am acutely aware of in Galway city, we went with the cross-party report, which was finally produced in May 2017. There were 46 key recommendations in the report covering many areas, one of which was the recommendation to roll out a regional framework. Since then, we have had the resignations of two senior figures and a third resignation, that of Professor McCarthy from the South/South West Hospital Group. What did Tom Keane say when he resigned? He said that "the requirements for implementing this unprecedented programme for change are seriously lacking." We do not know what Laura Magahy said, because when she met the Minister for Health it remained secret with him, although when he came out of the meeting his spokesman described the meeting as a "standard meeting around lots of issues" and looking at "various elements of the ongoing reform." That was the comment made about the Minister's meeting with Laura Magahy. The Minister for Public Expenditure and Reform stated earlier that there had been a meeting with Tom Keane. When did that meeting take place? Are there minutes of it? I understand the gentleman in question is out of the country.

I come from Galway city. Many people have suffered and are suffering as a result of public-private medicine and the failure to invest in public medicine. As Deputy Shortall said, Sláintecare was to be the blueprint for reform. I have repeatedly pointed out that it is unusual for doctors and consultants to write to us, but they have done so in Galway to tell us of the extraordinarily long list of people waiting, for example, for orthopaedic surgery following bone breakages. I have lost my train of thought because so much has happened in that time. Two theatres went out of action in 2017 and I understand they are now being built.

Rather than me coming in here on a regular basis talking about trolleys, long lists and letters from doctors and unions prior to Covid, outlining to us the delicate state of the health system, could the Minister please explain to us what the Government has done about the two senior resignations and the third one from Professor McCarthy from the South/South West Hospital Group?

I mentioned Covid-19, not as an excuse, but as a reality. The reality is that 5,179 people have died in Ireland with Covid-19. There have been points over the past 18 months when our system was under real strain, and we got through that thanks to the heroic work of our front-line workers in the HSE, allied health professionals and others working across the system. Despite that extraordinary strain, which we hope is a once-in-a-century level of strain that any health system would have to withstand, we have made real progress. When one looks at the report Laura Magahy brought forward - the implementation update in respect of Sláintecare - of the 112 deliverables for the first six months, 84 were on track, 25 were being progressed with minor challenges and three were experiencing significant challenges. That is 97% of those actions either delivered or on track. In the context of what we have had to live with, and what our system has had to coexist and grapple with over the past 18 months, that is a remarkable achievement. I look at the once-in-a-generation increase in the capacity of the health system, with the sanction provided for well over 1,000 additional beds in the acute hospital system. We do not have 20,000 beds or 30,000 beds; we have in the region of 11,000 beds. That is a dramatic increase and a step change that we have made in respect of critical care capacity as well.

The learnings of Covid have been relevant because we are going to have to future-proof our system for events like this that could well arise again. The Government is committed to the transformation of the public health system. It is not going to be easy and there will be challenges along the way. We must assess the reasons the resignations took place. That is why the Minister has had direct discussions with Laura Magahy and Professor Tom Keane and met the Sláintecare implementation advisory council. In the forthcoming budget we will see a further manifestation of the Government's commitment to delivering on the reforms.

Change is not easy but it is certainly not easy when one is living with a global pandemic that has taken more than 5,000 lives in this country. Our commitment is resolute, and it will be brought to bear and implemented through the decisions that we make working with all of the stakeholders across the health system.

There was no Covid in 2017. When the report was launched, it was because it was urgent and necessary. When did the Minister meet Tom Keane? Will the Minister please clarify that? When did that happen?

Regarding the roll-out of this programme, I hope I never hear a Minister stand up here again and use the deaths of people from Covid as an explanation for why there was no progress on the implementation of a plan that was necessary because of the deaths and illnesses of people who were suffering as a result of a completely dysfunctional health system. That is what we are looking at here. In Galway city, two orthopaedic theatres have been out of operation since 2017. Regionalisation is necessary, although we have gone through the dance before of the circular health boards - we abandoned them, brought in a health executive, had a board, abolished the board, brought the board back and now we are going back again to regionalisation. Covid did not stop regionalisation; a lack of willpower did.

Sláintecare should be located within the Department of the Taoiseach. Where is the interdepartmental committee with oversight? Where are the minutes of that committee? How often did it meet? Who is pushing this, notwithstanding that we must deal with Covid as a country?

The Minister, Deputy Stephen Donnelly, spoke with Professor Keane over the phone because he is in Toronto. He has spoken on more than one occasion with Laura Magahy since her resignation took place. He has spoken and met with the implementation advisory council and will now consider its request for an extension of time. We will consider that in the context of the consideration of what we need to do to strengthen the governance arrangements in respect of Sláintecare implementation. We are determined to get this right, ensure the governance is as strong as it needs to be and any obstacles and roadblocks in the system are removed because they are not at a political level. That is the commitment of the Government. We are providing the resources. Why does Deputy Connolly think we do not want to implement Sláintecare? We do. The increase in the capacity of the system that we have provided lays a very solid foundation for those reforms. The lack of capacity has been the single biggest weakness in the system in recent decades and it had to be fixed first. We are now well on the way to fixing that and we will make further progress on it across 2022.