Dáil Éireann díospóireacht -
Tuesday, 23 Nov 2021

Vol. 1014 No. 4

Ceisteanna ó Cheannairí - Leaders' Questions

An Leas-Cheann Comhairle

Before we start, I have a reminder about health and safety. Members and all in attendance are asked to exercise personal responsibility to protect themselves and others from the risk of contracting Covid-19. Members are strongly advised to practise good hand hygiene and observe the chequer-board seating arrangement. They should also maintain an appropriate level of social distancing during and after the sitting. Masks, preferably of a medical grade, should be worn at all times during the sitting, except when speaking. I ask for the full co-operation of Members in this regard.

Before we start Leaders' Questions, if everyone could comply leis na srianta ama, bheinn buíoch daoibh go léir.

Deputy Mary Lou McDonald

I send all of our best wishes to our colleague, the Ceann Comhairle, Seán Ó Fearghaíl, and wish him a full and speedy recovery.

The failure of the Government to plan for the Covid surge has created substantial pressure. GP services are overwhelmed, and schools are struggling. In large swathes of the country, people cannot get a PCR test while the Government still dithers on antigen testing. In our hospitals, especially ICUs, we see the sharpest impact. The capacity crisis in ICUs did not happen overnight. A HSE-commissioned expert report published in September 2009 recommended that the number of intensive care unit beds be increased from 289 to 579. Successive Governments have known about this problem for more than a decade and have done nothing. They cut a further 40 beds out of the system between the publication of that report in 2009 and the onset of Covid.

This lack of foresight has continued throughout the pandemic. The vaccination programme and lockdowns bought precious time to prepare hospital capacity for surges but the Government has wasted these opportunities. Even in the recent budget, it tinkered around the edges with ICU capacity. We do not have the necessary number of personnel to staff our ICUs safely, even in normal times. Experts tell us that we need between 150 and 200 additional ICU beds and more specialist staff for hospitals to cope. The failure to properly resource our hospitals has devastating consequences and serious knock-on effects for our society. Protecting our health service from collapse is a key reason for the prolonged use of restrictions.

Lack of capacity also has dangerous consequences for those requiring vital care and life-saving procedures. Earlier this month, a transplant operation was cancelled in Dublin's Mater hospital because no ICU bed was available. I cannot imagine how distressing this was for the patient, the patient's family and for the doctors who had to make this call. There should have been an ICU bed for this patient and there would have been if the Government had planned properly. We are already playing catch-up on missed non-Covid care. We are facing a tsunami of missed care in the coming months. Not having the additional ICU capacity is putting patients at risk. The Government continues to turn up a day late and a dollar short. We are two years into the pandemic and 12 years into the ICU capacity crisis and the Government has not even come close to doing enough for ICU capacity. As we watch our hospitals fill up again and restrictions are reimposed, people are asking what the Government is waiting for.

Tá an ganntanas leapacha sna hionaid dianchúraim, ICU, ag cur brú ar na hospidéil agus ag cur na n-othar i mbaol. Caithfidh an Rialtas rud éigin a dhéanamh go práinneach chun acmhainní na n-ionad dianchúraim a mhéadú go dtí an leibhéal riachtanach. What is the Government's plan for ICUs to meet this surge? What is the status of our surge capacity and when will it be deployed? Has the Taoiseach instructed the Minister for Health to begin properly and permanently resourcing our ICUs to the required levels in order that we do not end up here again?

The Taoiseach

Caithfidh mé a rá go bhfuil méadú tar éis teacht ar an méid leapacha atá againn agus go háirithe na leapacha ICU. Tá i bhfad níos mó díobh againn anois ná mar a bhí againn i dtosach na bliana seo caite agus níos mó leapacha i gcoitinne sna hospidéil chomh maith. Ta níos mó tástálacha ar siúl, ní hamháin antigen ach na cinn PCR freisin, suas 200%. There are four broad areas where we have to deal with this fourth wave. Overall, Ireland's performance so far in terms of the pandemic, on the key metric of mortality and in terms of protecting life and severe illness, stands up to most countries across Europe and the globe. We have been, relatively, in the better position consistently for quite some time because of measures that we have taken. That should be acknowledged.

I can inform the House that the booster campaign is well under way, with over 600,000 boosters having been already administered. This is on top of a record and highly effective overall vaccination roll-out programme in which we have close to 93% of the adult population fully vaccinated.

In terms of hospital beds, we have provided close to 1,000 extra beds overall in 2021, with more still to be provided. In the last year and a half to two years, there has been a dramatic increase in the number of hospital beds. In terms of intensive care beds, we have gone from 225 to 300 within the system but we will have to go further in 2022, at a minimum to get to 340 intensive care beds. I would like to go beyond that. We have recruited close to 11,000 people throughout 2020 and 2021. The key issue now is not resources, because the Government has provided the resources for intensive care beds, hospital beds and additional staff, but the speed at which we can recruit and provide the entire capacity that an ICU bed requires. We have surge capacity to 350, if necessary.

The hospitals are under pressure because of a very transmissible variant, namely, the Delta variant. That is now manifesting itself in a fourth wave. Parallel with that has been the reopening of society. We have not had prolonged restrictions. We have reopened the economy and we have reopened society. Let us be honest, the increased socialisation that automatically follows that degree of reopening of almost all sectors of the economy in society leads to an increase in infections. This is a balance that we have to strike. Thousands of people have returned to work and that is good for those people in terms of their individual lives and so forth. The overarching objective of our policy in regard to Covid is to protect lives and to prevent severe illness. The motivating factor in terms of our responses now is to stop people getting Covid and to stop people getting sick and severely ill from Covid. There are a number of ways we can do that. It is through a combination of all of those ways that we do it.

In regard to the operation, I believe it should have gone ahead. There is enormous pressure on the Mater hospital. I set up that unit when I was for Minister for Health. We broke new ground in terms of heart and lung transplant. There was a big debate at the time as to whether we could pull that off in terms of the numbers of cases coming through the country. I took a decision at the time to do it and to fund it. It is a cause of great regret to me that a transplant did not go ahead. There is an internal inquiry or investigation going on within the Mater in that regard. Suffice to say, we will do everything we possibly can to protect lives and to protect people from getting very sick from Covid.

Deputy Mary Lou McDonald

Despite the Taoiseach's attempts to reassure or to advance the pretence that we have enough capacity in our hospitals, the evidence is that we had staff protesting outside Connolly hospital and, for example, in Limerick hospital other beds are being repurposed for use as ICU beds.

It is very clear the capacity falls well short of what is needed and that fact was established as far back as 2009. The fact also is that there was not an ICU bed for that transplant operation to occur, which was very traumatic for all concerned, particularly the patient and the patient's family.

To make it clear for the Dáil, what is the plan now for ICU capacity as infection numbers are growing and hospitalisations increase? The Taoiseach has confirmed we have a surge capacity; to 350 I think he said. When will that be deployed? When will the Taoiseach and Minister for Health make the permanent investment we need in ICU to get us to a reasonable place where we are not constantly facing this danger and jeopardy?

The Taoiseach

As I said earlier, the intention now is to go, at a minimum, to 340 by the end of 2022. We are at close to 300 or 301 at the end of this year and we need to expand it even further. Recruitment and training of staff will be the key ingredient there; it will not be an absence of resources. Currently, we have 130 people in ICU, as of today, and 638 in hospital. These are large numbers which, in themselves and in addition to non-Covid illnesses, are creating a lot of pressure on intensive care staff and hospital staff in general, who have had to deal with a once in a century pandemic for the guts of two years. That is extremely pressurising on any employee, particularly patient-facing employees and those in the engine room of the ICU in particular. It is very challenging and difficult and I acknowledge that. This is why we have made it clear we will provide whatever resources are required to continue to give the capacity to the HSE in terms of how it operates hospitals and so on, with the clinical staff needed to deal with the situation.

Deputy Duncan Smith

I would like to pass on my best wishes to the Ceann Comhairle and wish him a speedy recovery from Covid-19.

I want to continue on the issue of capacity in intensive care units. As stated, an organ was unable to be used for transplant because of a lack of capacity in ICU. Transplant operations are very complex and may, on many occasions, be cancelled for a number of compatibility reasons. However, for an operation to be cancelled because of a lack of an ICU bed is cripplingly devastating to the person who needed that transplant and the person's family. It is also very difficult for organ donors and their families throughout the country, who really want their organs to go to help and cure others.

The Government is struggling to run the country around a hospital system that is breaking down. That is a fact. We are creating policy and trying to protect our society around a hospital system that is broken down. At the centre of that is ICU capacity. The EU average for ICU beds is 11.5 per 100,000 of population. In Ireland, it is just under 6.5 per 100,000. The Department's own capacity review in 2018, before Covid, undertook to have 330 ICU beds by the end of 2021. The Taoiseach mentioned that resources are not an issue. However, we are at the end of 2021 and, at just under 300 beds, we are nowhere near 330. With resources not being an issue, why are we not near that target?

Dr. Catherine Motherway, in another arresting contribution on "Morning Ireland" this morning, said that, with the Delta variant, it is likely that everyone in this country will get Covid at some stage and it is vital we slow down that spread. Unfortunately, the booster campaign is playing catch-up with a virus that is running rampant throughout our society. Delayed decision-making from the Government has impacted the ability of the booster campaign to roll out effectively. Some people are being called for boosters very early but there are older people who have not been called yet. They are waiting by the telephone for a call that has not come and are losing faith it will come. The world-beating mass vaccination infrastructure that made us so proud is still focused on the first and second vaccines, not the booster. When will that infrastructure be shifted to the booster campaign? At the moment, it is going primarily through the GP service and that is leading to delays, frustration and people not getting their booster in time.

Tens of thousands of people are trying to get PCR tests, with demand outstripping supply. How many permanent intensive care unit, ICU, beds, not including surge capacity beds, will be in place by the end of this year? What long-term planning is the Taoiseach doing to ensure that we meet not only our own targets, but that we get up to the EU average of 11.5 ICU beds per 100,000 people?

The Taoiseach

It is not the case that the booster vaccination infrastructure is just focused on the primary doses, which are doses one and two. It is important that we continue to do the vaccinations. Some 1,900 people came forward over the weekend for their first dose. That is good news. Those were people who may not have been easily accessed by the system, but they came forward to vaccination centres. We have to help people consistently to access our system. We have had a voluntary system so far. It has been spectacularly successful, if we are honest, for dose one and dose two, compared with other countries that are getting more hard line and mandatory in their approach, but are still at approximately 60%. We are at 90% plus. We just need to work with particular groups that may not have had the same degree of confidence in the vaccines as the general population has had. That is beginning to yield fruit. The vast bulk of the vaccinations now are booster vaccinations and over 600,000 have now been administered. The GPs were always the conduit for administering vaccines for the elderly cohorts of the population. As one moves down the age cohorts, there is greater utilisation of vaccination centres and healthcare workers as well. There is a variety of options for healthcare workers. There has been very good progress made in over 80s and over 70s - very good progress was made last week - and over 60s. The booster campaign is progressing apace. It will increase in capacity. One cannot go earlier than five months to get a booster. There is no clinical mandate from anybody to go earlier than five months. One has to wait for five months after the second dose before one gets the booster. The pharmacies are on board now. The pharmacies, the GPs and the vaccination centres are all on board with the booster campaign in particular. There is no issue with supply in the boosters.

On testing, we should acknowledge that last week and in the last seven days, 207,000 PCR tests were done. That is an extraordinary number in itself, given the size of our population. We have now been hitting 200,000. Every available mechanism is being used to increase capacity on PCR tests. We have also broadly widened participation in antigen testing, particularly through close contacts. There are now 3,000 close contacts per day being issued with free antigen tests. The schools, working with the HSE, on 29 November will begin the operationalisation of the use of antigen testing in school settings, where appropriate. We have used thousands and thousands on serial testing in agriculture. That figure is close to 150,000.

Deputy Duncan Smith

On the ICU beds, where will our permanent ICU capacity be at the end of this year? There is no doubt that we are doing an unbelievable number of PCR tests. However, the Government has had to get the private companies into Dublin, Cork and now Shannon airports to try to meet demand. Last year, I and others in opposition asked the HSE to set up facilities in airports. The Opposition has been trying to give practical solutions over the course of this pandemic. If we had been listened to at the time we would not be scrambling for private capacity to be used to try to meet demand for PCR testing. It is still not working. It is still not enough. We still cannot get tests. If you logged on right now at lunchtime in this country, you would not be able to get a test. You would have to stay up late until 12 midnight and refresh screens to try and get a cancellation test. It is just not good enough. People are really upset out there. They are expecting restrictions coming down the line. That is the message I have been getting all the last few days, that further restrictions are coming down the line. The Taoiseach’s Government is going to have to get straight with people. They are going to have to make long term plans and stop operating as if this wave will be our last. We need to operate as if this virus will be here for the next couple of years, as the World Health Organization, WHO, says, and plan accordingly.

The Taoiseach

We have planned and we are planning accordingly. The number of ICU beds at the end of this year will be 301, give or take. Resources were provided for 321 beds.

There have been challenges as regards recruitment but about 11,000 people have been recruited in two years and the aim is to get to 340 beds, minimum, by the end of 2022. I would like to go further if we could and progress it and increase it even further after that. This Government has taken major decisions around ICUs. We have gone from 255 beds to 300 in a very short space of time. ICU beds are not simply beds. The Deputy knows that and I appreciate that.

On the PCR tests, we need to be fair and balanced and have a sense of perspective. Having a capacity of 207,000 is not scrambling around. The amount of private sector additionalities is low in comparison to the core capacity provided by the HSE. Credit where credit is due and it should be given to the HSE in respect of the capacity that it has built up for PCR testing. That is a good thing. It is looking at every possible way to increase it even further. We compare well with other countries as regards our capacity for PCR testing.

Deputy Richard O'Donoghue

I also pass on my best wishes to the Ceann Comhairle for a speedy recovery.

Inflation is at a 14-year high thanks to the rise in energy costs, supply shortages and increased demand following the post-Covid reopening. The Central Statistics Office has confirmed that the rise in prices in October was the largest seen since April 2007. The squeeze on the household budget is due to the Government over-exhausting and crippling the PAYE sector, particularly those living in rural areas. I am going to make it very simple. I have a payslip here from week 33 of the current tax year. If someone earns €500 net into their hand per week, it will cost the employer and the employee €680.65. The employer pays €67.73 PRSI for the employee, who is a single person. PAYE deducts €74.22 per week while the USC deducted is €14.18 and the PRSI €24.52. That is €180.65, which allows the employee to take home €500 per week. Now we must adjust this for the cost of living. An average person commuting to work and with family commitments, in County Limerick, will spend €100 a week on fuel. The Government takes €57 out of that €100. Food for a single moderate person is €20 per day, which equals €140 per week. The Government gets €26 out of that. The ESB bill costs per week €30 and the Government gets €6.40 out of that. Heating costs, which include coal, timber or oil to heat the family home, are roughly €40 per week and the Government takes €7.48 out of that. Clothes and footwear cost about €1,560 a year, which equals €30 a week, and the Government takes €6.40 out of that €30. If this person is lucky enough to rent a room at €100 per week, the Government takes a further €10 out of that. They are then left with €60 for miscellaneous things. God forbid they want to get a pint, go for a meal or go to the cinema with that €60 because the Government will take €12 of that.

The Taoiseach

The Deputy used the phrase, "the Government takes". Who is the Government?

Deputy Michael Healy-Rae

At the moment it is your party.

The Taoiseach

This is a very simplistic kind of presentation, which goes on all the time. It is the social contract, to varying degrees. We might disagree as to where the balance of the social contract is but the social contract is society raising revenue through the elected government of the day and rebalancing that revenue out in education services, childcare services, health services, mental health services and infrastructure.

These are the very issues that Deputies will consistently come into the House and raise with Ministers, asking why we do not have extra money to spend on this or on that. We have a very strong social welfare code in Ireland which requires a lot of revenue and that revenue has to be raised. Substantial revenues have to be raised. People may argue that it is not enough and others will argue differently but we cannot get away from the fact that huge sums of money are involved in social protection, education and health in particular which reflects the majority view in terms of how we want to organise society. The Government must raise revenue on behalf of society to be able to do the things it wants to do and that involves PRSI as well. One of the big challenges in higher and further education is the need to dramatically increase the number of skills programmes to upskill the economy for retrofitting, offshore wind and apprenticeships generally across all of the trades. That is working and the funding we have provided is definitely yielding results in terms of increased applications for apprenticeships.

A balance must be struck but I accept that there is a big pressure on energy prices at the moment. I have no doubt about that and agree with the Deputy. We brought in a modest taxation package in the budget which was designed to make a contribution towards helping people. We also increased the fuel allowance and provided other welfare increases to try to cushion the blow from higher energy prices. The Government is keeping under review the issue of the impact of global energy price increases on households. I fully accept that energy prices are putting pressure on many families and households but this is very much a global phenomenon. The European Central Bank is saying that it will be a short-term issue and that after the first quarter of next year, prices will begin to recede but we will have to monitor and review that very closely to see what further help we can give.

Deputy Richard O'Donoghue

The Taoiseach's answer to the people was to put a 2% increase on fuel. Who pays the most? The Government is taking 45% of a wage. I have asked the Taoiseach today about the rural person because there is no infrastructure. The Taoiseach mentioned infrastructure two or three times in his deliberations. If I was living in the city I could choose the Luas, the train, the DART, the bus or I could cycle or walk. There is none of that outside the city boundaries and the Government's failure to introduce infrastructure outside the city areas is what I am talking about. I am talking about the rural person outside the famous Red Cow roundabout. Everything outside that is rural and everyone outside of that has no infrastructure so they pay the most. If you live in the city, you have a choice but there is no choice in rural areas. That is why I am asking the Taoiseach to consider something like reducing the VAT or we will not have food on our tables this winter.

The Taoiseach

First, in terms of rural Ireland, a major and unprecedented initiative was taken to increase the allocation of resources for a rural transport scheme. The only city that has Luas and DART services is Dublin. The other cities do not have those services although we are trying to develop a more expanded bus network. That is acknowledged. We are one of only a few EU countries that by way of a special derogation from the general EU rules already apply a reduced rate of VAT of 13.5% to energy prices. Under EU rules, this rate cannot be reduced below 12% so if we were to attempt to reduce the rate to 9% for a few months, for example, I am informed that the VAT rate would afterwards revert to the standard rate of 23% and our special derogation would be lost. The VAT reduction option is not as simple as it has been presented in the House and could have serious repercussions down the line. What is important is that we look at ways to cushion families against the impact of increases in energy prices and we are keeping that under review.

Deputy Marian Harkin

I also extend good wishes to the Ceann Comhairle.

Like many in this House, I have had countless emails and calls from school principals, parents, students and teachers, all of whom are extremely concerned about the issue of substitution for teachers who are sick or self-isolating due to Covid.

It is important to say this is not a new or unexpected problem. Covid has exacerbated it, but it is still an issue. I raised this several times with the Minister for Education last year and she kept telling me about the supply panels. I will come back to that in a moment. The Irish National Teachers Organisation, INTO, did a survey in November which showed the extent of this problem. In many ways, we were ahead of it in Sligo because a number of surveys were done in September and October in 32 schools, where there were 473 absences that required substitution. Some 22 schools, or 69%, had access to supply panels. The panel for those 22 schools supplied 15% of the substitutes. Some 27% of cases were covered either by special education teachers or principals, or were simply not covered. Of the remaining ten schools that did not have access to supply panels, there was no substitute available 34% of the time. That is one in every three days. They were mainly the smaller schools that do not have flexibility within them to juggle teachers. Many comments were made by teachers and principals about this, but I do not have time to read them. Basically, they are saying that they make between 15 and 25 calls and they cannot get substitutes. This is a crisis. It is worse now than it was before.

Today, we hear the Minister is meeting representatives from the teacher education colleges, but this should have happened this time last year. This is bad management. I hate to say that, but it needs to be called out for what it is. When we are in a crisis we must take unprecedented actions. The Taoiseach has done this in other areas, so I do not know why it has not been done in education. Many fourth year students in teacher training colleges are already substituting, so one could ask where we look. Do we look to retired teachers, teachers on secondment or those in the inspectorate for a short period to get us over this hump? It is not ideal. Nothing is ideal in a pandemic and anybody who says it is, is not reasonable, but we expect proper planning to deal with this ongoing and escalating problem. I ask the Taoiseach what we are going to do.

The Taoiseach

I agree with Deputy Harkin that given the once-in-a-century nature of the global pandemic we need to take measures now in respect of teacher substitution which we would not take in ordinary "peace" time. I will put it that way to the Deputy. That does mean that all stakeholders, be they regulatory or unions, must show some degree of flexibility as well. Today's meeting with the higher education institutions is not the first engagement between the Minister and the institutions. There have been challenges in terms of attendance for the theory side and so on. In my view, flexibility must be shown in regard to student teachers, as they could go a long way towards helping.

In addition, we must look at other areas. Retirement has been considered and good, constructive flexibility has been shown by the Minister for Public Expenditure and Reform in terms of facilitating additionality in that regard. The Minister is exploring other areas with the education partners. Flexibility should be shown on all sides to get us through this period in respect of substitute teachers. The Minister has already provided significant additional resources in terms of the further 100 teachers who were allocated to supply panels where the Department had identified areas of greatest need. The supply panels now employ 480 teachers. They provide substitute cover to almost 2,600 primary schools across the country. They work alongside the more traditional existing methods of sourcing substitute teachers such as the national substitution portal service, subseeker.ie, operated by the Irish Primary Principals Network and developed under the Department's teacher supply action plan. In any one month or year, there can be a whole variety of reasons substitute teaching is required to replace existing teachers.

Notwithstanding that, given the fact we are in the middle of a pandemic, we have to show, and all the stakeholders involved, in my view, will have to show, flexibility in respect of the utilisation of student teachers and, indeed, other alternative methods of providing teachers. We have many qualified people who may not necessarily, for example, have the teaching qualifications per se but who would have degrees and so on. These are issues we need to look at. Given the circumstances and given the fact the vaccination campaign has been very strong and the booster is rolling out, if everybody put their heads together, we could get a resolution to this or certainly alleviate the situation.

Deputy Marian Harkin

As the Taoiseach said, it is a once-in-a-century happening. He said that all stakeholders have to show flexibility. Has there been inflexibility and, if so, how does he believe we can get over this issue? I agree the Minister has given resources but the truth is they are not enough because it is a once-in-a-century happening - the Taoiseach said it himself. Therefore, in a situation like this, we have to make sure the resources we put in place will support the systems, like education, which the Taoiseach and all his colleagues believe is one of the most important systems to support. The Taoiseach spoke of supply panels. All I can tell him is that one third of schools in Sligo do not even have access to supply panels, never mind being able to get teachers from them. This is a once-in-a-century emergency situation and I believe that insufficient planning has gone into dealing with it.

The Taoiseach

First, in wrapping up, I want to send our best wishes to the Ceann Comhairle and to wish him the very best in his recovery from Covid-19.

I believe in flexibility at moments like this. This is not related but I will make the point. I remember many years ago, when I was the Minister for Education, the idea of introducing a qualified Montessori teacher to primary schools was something that was anathema to all and sundry who are in primary education. There can sometimes be too rigid and bureaucratic an approach to what we should do in the middle of a pandemic like this. That is my point. I am sure the stakeholders will work with the Minister to resolve this. The Minister has gone a long way in terms of providing the resources and it is not a funding resource issue. I think the student teachers offer an opportunity, as Deputies articulated last week, in particular Deputy Cathal Crowe, and there are other issues around the 22 hours, for example, and the mechanisms there. All of that needs working through with the Teaching Council and the unions, and there are all the different permutations to this.

An Leas-Cheann Comhairle

I thank Members for their co-operation. I hope it continues to the next item.