Léim ar aghaidh chuig an bpríomhábhar

Dáil Éireann díospóireacht -
Thursday, 25 Nov 2021

Vol. 1014 No. 6

Ceisteanna ó Cheannairí - Leaders' Questions

Roimh na Ceisteanna ó Cheannairí, I must read out a health and safety note. Members and all in attendance are asked to exercise personal responsibility in respect of protecting themselves and others from the risk of contact contracting Covid-19. Members are strongly advised to practise good hand hygiene and observe the chequerboard 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 Members' full co-operation in this regard and on the srianta ama freisin.

Gabhaim buíochas leis an Leas-Cheann Comhairle. I begin by extending my sympathies and those of my party to the families and friends of the 27 people, including children, who died in the English Channel yesterday. This tragedy, I am sure the Tánaiste will agree, underscores the need for Europe and Britain to respond comprehensively to the issues because the current approach is simply not working. Ar dheis Dé go raibh a n-anamacha.

Tá fadhb mhór ann maidir le tástálacha polymerase chain reaction, PCR. Níl siad le fáil i mórchuid den Stát maidin inniu. Go simplí, tharla sé seo mar nach bhfuil an plean ag an Rialtas le dul i ngleic leis an bhfadhb seo. Tá an phaindéim linn anois le thart ar dhá bhliain. Tá fadhbanna ann go fóill ó thaobh ár seirbhísí sláinte, lenár n-otharlanna, lenár scoileanna agus níl plean ar fáil go fóill maidir le tástálacha antigen ar chostas saor in aisce nó réasúnta. Ar an Rialtas atá an locht seo agus níl dabht ar bith ina thaobh sin.

I am sure we have all seen the comments this morning on social media and the bit of banter about how it is easier to get Garth Brooks tickets in this State than a PCR test. Other posters say they have Garth Brooks tickets which they are willing to swap for a PCR slot. While that might be a bit of light banter, the reality is very serious. It is impossible to book a PCR test in most of the State as we speak. There are no slots available in Dublin, Carlow, Cork, Kerry, Kildare, Kilkenny, Laois, Leitrim, Louth, Meath, Offaly, Tipperary, Waterford, Westmeath, Wexford or Wicklow. There are no slots to be got for love nor money. In other counties there are a number of slots left, which I am sure will be gone in the next number of hours.

This is a direct result of the Government’s failure to plan, which has been seen time and again throughout the course of this pandemic. We see GP services overwhelmed and schools that are struggling and we still do not have a plan from Government to make antigen tests free or even subsidised. Nearly two years into this pandemic, we have a system that needs to be equipped to cope with higher levels of transmission, which were always a possibility. When we reopened our economy there was always a chance of higher transmission. Therefore, plans needed to be put in place and executed but the Government has failed drastically in this matter.

In our hospitals, especially intensive care units, ICUs, we see the sharpest impact. The ongoing capacity crisis in ICUs did not happen overnight or in the past number of months or, indeed, years. It is a legacy of successive Governments and Ministers for Health. The Tánaiste was one of those Ministers for Health and he was also Taoiseach during part of that time. The vaccination programme and restrictions gave us time to prepare our hospitals for the surges but that opportunity has been squandered. On the brink of Christmas, we now find ourselves in another crisis. That is inexcusable.

I heard the Tánaiste speaking on radio this morning. He does not seem to understand that for many people, not having access to a PCR test is the difference between getting paid or not. It is all well and good saying people should take a few days off while they wait for a test but for many workers and families, that is simply not an option. The Tánaiste's continued failure, as Minister for Enterprise, Trade and Employment, to put in place a sick pay scheme has made this situation worse for thousands of workers.

Some counties have a very real problem, particularly in the east and south east, where people can wait for up to three days for a test. The HSE needs to be managed in respect of its resources and ensuring they are deployed where they are needed most. We need to boost capacity into the public system. We will have a need for a high volume of testing for the foreseeable future. We need an all hands on deck approach. We also need resources for laboratories and medical sciences and we need a quicker turnaround time.

I ask the Tánaiste to outline to the public, particularly in those counties where thousands of people cannot get a test today, what the Government is doing to respond to this. What is the plan or is it a case of the Government simply closing its eyes, crossing its fingers and hoping this goes away?

There has been extremely high and sustained demand for Covid-19 testing at community test centres over the past number of weeks. This reflects both the high prevalence of the disease in our community at the moment but also the fact that there are many other respiratory illnesses and viruses circulating in the community. With so many people, hundreds of thousands of people every day, experiencing symptoms of cold, flu, Covid-19 and other illnesses, no system in any country could cope with this level of demand. That is the situation we are in now. As is the case during many periods of the pandemic, it is necessary for us to prioritise and adjust testing criteria in order to prioritise those most in need of a test.

The system is operating in excess of surge capacity and, as a result, decisions in respect of the prioritisation of test availability have been necessary. Priority is now being given to those for whom a GP believes a test is warranted and close contacts who are symptomatic. Those two groups are having their tests prioritised. Ensuring these two groups are prioritised does not mean that test slots may not be available on the booking portal at a particular point in time. It is important to say, however, that the system is constantly monitored and extra appointments are added throughout the day. We now have the capacity to test over 30,000 people a day, which is more than was ever the case at any point in this pandemic.

The high prevalence of Covid-19 in the community and the extremely high demands on the testing system make it prudent from a public health point of view to adhere to appointment-based testing at this time. The HSE is making every effort necessary to respond to the very significant demand arising for PCR testing, including the recruitment of additional community test centre staff and also making arrangements with private providers, where available.

Despite any delays that may be experienced, it is critical that we reiterate the public health advice that if people are experiencing the symptoms of Covid - a high temperature, a new cough or a change in perception of taste or smell - they should restrict their movements, stay at home and avoid interacting with other people in their household, at least until they have the test and get their test result back.

It is also important to point out in response to the Deputy’s comments that people who are off sick with Covid, have been told to self-isolate or are at home waiting for a test do qualify for the enhanced illness benefit payment. That remains in place and is paid at a much higher rate than is the case in Northern Ireland, for example, where the Deputy’s party has been in charge of the administration for more than 20 years.

On sick pay, as a Minister, I am personally committed to sick pay legislation and I am determined to get it over the line. Legislation is currently in committee and is being scrutinised by the Joint Committee on Enterprise, Trade and Employment, which is chaired by a Sinn Féin Deputy, as Deputy Doherty knows. I appreciate that the committee wants to carry out the scrutiny thoroughly but I encourage it to complete that pre-legislative scrutiny sooner rather than later so that I can bring the legislation into the House. That is the rate-limiting step at the moment.

As we come into the winter period, we will always have an increase in respiratory illnesses. We have this conversation every year; it is like déjà vu. The problem is not that we are in the winter period or the flu period but that the Government has not planned. It has not planned for increased capacity and, therefore, in most of the State people cannot get an appointment for a PCR test today.

I echo the comments the Tánaiste made on the public health advice.

People should follow that advice. However, as we ask the public to step up, as we ask people to make sacrifices, isolate themselves, stay away from family and curtail their contacts, as we ask people who work in the night-time sector to close down that sector during specific periods, people are also asking the Government to step up and to respond. We need to increase capacity and have an approach that is all hands on deck. There is no guarantee that, in January, we will not have additional need for PCR tests. Where is the plan for additional capacity in order that people in these counties can book a test if they need one?

Go raibh maith agat, a Theachta.

When is the Government going to come forward with a plan in regard to antigen tests?

The problem we are facing is that we have a pandemic that is not under control and is unpredictable. We have capacity to carry out approximately 30,000 PCR tests a day in our swabbing centres and even more than that in our laboratories, but there are limits to capacity in any system, in any country. When we have a situation where, on any given day, there could be hundreds of thousands of people with respiratory symptoms, there is no capacity that could deal with or cope with that.

What are the limits?

That is why we have to prioritise and it is not the first time we have had to do so during the pandemic. From time to time, we have to prioritise testing those who need the test most. We are prioritising those with a GP referral and symptomatic close contacts of people who have Covid. From time to time, NPHET has had to change the testing criteria and that may be necessary again because there is only so much capacity you can possibly have in any testing system. It is no different north of the Border and in other parts of Europe and the world.

In terms of what the Deputy said about capacity, for anyone who is interested in facts - there are some people, at least, who are interested in facts - it is worth reading Health in Ireland - Key Trends 2021, published by the Department of Health the other day.

Thank you, Tánaiste.

We have been increasing the number of hospital beds in Ireland since 2015.

We have 900 more beds today than we had before the pandemic began. There are 600 people with Covid in hospital.

Tá mé ag bogadh ar aghaidh.

We have 44% more doctors in Ireland than we had ten years ago.

There are 14,000 beds now, compared with 22,000 before.

What about ICU beds?

There are 300 ICU beds now and we have funded for 340.


Táimid tar an am. Bhur dtacaíocht, más é bhur dtoil é. The next speaker is Deputy Cairns for the Social Democrats.

This is no country for young people and we have more evidence of that today. A new report has shown that the number of first-time buyers aged 30 or under has collapsed in the past 16 years, falling from 60% in 2004 to just 27% in 2020. These figures, while shocking, are just further confirmation of what we have all known for some time, which is that young people in Ireland have been handed a poisoned chalice. They will be the first generation who are less well off than their parents. Stagnant wages and soaring housing costs are largely to blame.

In the past eight years, house prices have doubled, growing by more than 12% in the past year alone. Rents have also doubled in a decade. While housing costs have skyrocketed, wages have flatlined and low pay is endemic. Is it any wonder that people in this cohort cannot buy a home before they hit 30? Many cannot even find a place to rent; buying is just a pipe dream. Generation rent is, in fact, generation spent, with a huge proportion stuck living at home. The census in 2016 found 50% of adults aged under 30 were living with their parents. What will that proportion be when the next census is published next year?

The job prospects and earning capacity of many of those now in their 30s were decimated by the crash in 2008 and have never recovered. The pandemic has further compounded this disadvantage, disproportionately impacting on young people's educational opportunities, social lives and earnings. When businesses closed, it was predominantly young people who lost jobs. Employment fell 14% below pre-pandemic levels for those aged 15 to 34, compared with just 6% for those aged over 35. The pandemic unemployment payment, PUP, was supposed to be evidence of a social contract extended to workers who lost their jobs to protect public health. That has been closed to new entrants and cut for existing recipients, despite the continuing restrictions in some sectors. Added to the mix now is a cost of living crisis that has seen inflation balloon to a 13-year high, making it even harder for people to make ends meet.

I have three questions for the Tánaiste. Why should young people have any faith in his Government? What is he doing to tackle the myriad cost of living crises young people face in this country? What is he doing to ensure history does not repeat itself and young people do not suffer the detrimental economic legacy of this pandemic in ten years' time, as happened after the 2008 crash?

I thank the Deputy for raising these matters. First, I am somebody who believes in home ownership. This is a Government that believes in home ownership. I am not sure that is really true for many of the people opposite or on the left of politics in Ireland. Some 70% of people in this country own their own home and we want that to be a reality for people in their 20s and 30s. A huge part of our Housing for All policy is making the dream of home ownership a reality for more people in Ireland of all ages, particularly those in their 20s and 30s who now find it so hard to get a mortgage and find a home they can afford to buy.

What are we doing? We are increasing supply. Just in the past 12 months, the number of new homes that started construction hit 30,000. That is really encouraging. It is not so long ago that only 5,000 or 6,000 new homes were being built in Ireland every year. We are now up to approximately 30,000 new homes being built every year. As those homes become available, we will see more people being able to buy their first home, which is really encouraging. It is disappointing to see so many people, including members of the Deputy's party, objecting to new homes being built. In Drumcondra, for example, people objected to homes being built because they are one-bedroom apartments. Surely the Deputy knows how many young people are single. One of the changes that has happened in our society is that people tend to form their households later in life, get married later and be single for longer. Objecting to housing on the basis that it comprises one-bed apartments, as the Social Democrats so often does, really misunderstands the fact there are so many single people in society now. In fact, one of our biggest deficiencies in housing supply in Ireland is that we are a country of three-bedroom homes, by and large, and we do not have enough one-bedroom homes. I really encourage the Social Democrats to end its opposition to one-bedroom apartments and housing of that nature because I think it is wrong-headed.

Another thing we are doing is the help-to-buy scheme which, again, was opposed by a lot of people in this House. Very many of the people, particularly younger people, who have managed to buy a home for the first time in the past couple of years were able to do so because the help-to-buy scheme helped them to raise a deposit. That would be taken away from them if this Government was removed and replaced by a government of the left. Such a government would take that away. It might help them with a rent credit or something like that but it would take away 20 times more by getting rid of the help-to-buy scheme. I encourage all Members opposite to reconsider their opposition to the scheme, because it is one of the things that helps younger people, and young couples in particular, to buy their first home.

We are also making mortgages more available. A lot of people are paying very high rents of €1,500 to €2,000 a month or even more but cannot get a mortgage that would cost €1,500 or €1,400 per month. This leaves them trapped paying very high rents, unable to get a mortgage they could afford to pay. We are helping with that by expanding the Rebuilding Ireland home loan scheme to make it available to more people and making it a local authority loan.

Thank you, Tánaiste.

I am glad to see today that the Central Bank has announced it will allow lenders to take part in a shared equity scheme, which I think will be of benefit too.

It is very telling that in response to three very important questions, the Tánaiste used his time trying to slate the Social Democrats in regard to what our approach to housing might be in government. He says he believes in home ownership and the Government's policy is aiming for that and will achieve it. However, its big idea to boost affordability for young people is the shared equity scheme, which fails to make houses more affordable and heaps extra debt on first-time buyers who must, in effect, pay for the unaffordable cost of homes. There is nothing new in the Government's housing policy. It is still wedded to the same developer-led approach. People have said time and again that insanity is defined as doing the same thing over and over again and expecting a different result. Nowhere is this more evident than in the Government's housing policy.

If these issues are not addressed, they will continue to fester and things will only deteriorate. The Tánaiste and his party have been in power for nearly 11 years now. The responsibility for young people's dwindling opportunities and ability ever to own a home rests squarely on this Government and the Tánaiste's previous two Governments. It is unbelievable that he would stand up and slate the Social Democrats approach to housing policy.

Thank you, Deputy.

Will he please answer my questions?

I think it is entirely reasonable for the Deputy to criticise the Government and my party.

I do not think it is reasonable for the Deputy to say that her party should not be criticised or be subject to any analysis or criticism at all. That is very one-sided. I ask her to reconsider that comment.

We have 70% home ownership in Ireland. We have one of the highest rates of home ownership in the world.

I am talking about young people aged under 30.

That did not happen because of the Social Democrats. It happened because of policies pursued for generations in Ireland. That is not the reality for a lot of younger people in Ireland. Most of our housing policies are now orientated towards trying to increase home ownership in Ireland and make it possible for more people to buy homes. Shared equity is part of that. I have seen it work in my constituency, where people who are renting and unable to afford a home can do so through shared equity. We will see a lot of demand for that. It is not the only solution, but it is part of the solution. Help to buy, shared equity, supporting the building of new housing and making mortgages more affordable are all things that we are doing and all things the Deputy's party will not support.

I, too, want to show our solidarity to the poor people who died crossing the English Channel in an absolutely awful situation.

This pandemic has shown us many of the good and not so good things about this country. It has shown us who we are and where we want to go. It has brought out the best in our people. Collectively, we have responded to the call of social solidarity to watch out for one another. It has brought many of us together who were never brought together before.

The ongoing public health emergency continues to create anxiety, grief and fear. I would argue that this pandemic raises the question of what is important in society. One of the issues is our health service. We have never before needed it to protect us and care for us more. Last year's general election was a political earthquake. It was a message to the political establishment that people had had enough of the state of our two-tier health service.

Almost a million patients will be on waiting lists by year end, with almost 300,000 people waiting over a year for treatment. There are only three hospital beds per 100,000 population whereas the OECD average is five per 100,000. One in five consultant posts is vacant and our ICU capacity per capita is little more than average for the OECD. We have some of the most dedicated and best educated staff in our health system.

Our two-tier health system has been shown to be deeply flawed and unequal. This is due to the historical legacy of cuts to beds and health resources. We can argue all day about who did what. This Government and previous Governments have advocated for private healthcare competing against the public system. Does the Tánaiste have the stomach to reverse past and present cuts? Can he grasp the challenge that the electorate of the country set for Fine Gael and Fianna Fáil when they said this is no longer good enough and public services such as our health system are paramount? We want a universal health system that looks after people, whether they are a millionaire or on social welfare. If we do not have that, there will be a price to pay.

I thank the Deputy. I acknowledge the simple fact that our public health service is too small for a population of 5 million people, which is also an ageing population. That is not the only reason but one of the reasons too many people have to wait too long for the health care they need. I fully acknowledge that.

The Deputy asked me if I have the stomach to reverse the cuts to our health service. I have more than the stomach for it. That is exactly what I have been doing during my time in government. From the moment it became possible, around 2014 or 2015 when the country exited the IMF bailout programme, we have expanded and invested in our health service. The Deputy does not need to take my word for it. He can check out the report, Health in Ireland: Key Trends 2021, which was published the other day. It will tell him exactly what has been happening in our health service over the past couple of years.

In 2015, I took the decision to reverse the policy of reducing the number of beds in our health service. Every year since 2015, we have seen an increase in the number of hospital beds in Ireland. At a time when most countries are reducing the number of beds, we have been increasing them. That is why we are getting closer every year to the OECD average the Deputy mentioned. We have 900 more beds today than we had before the pandemic began and roughly 2,000 more beds than we had in 2015.

The report to which I referred also shows that there are 44% more doctors in our public service today than there were ten years ago. How many people know that? It is a fact. There are 44% more doctors working in our public health service now than there were ten years ago. There is a health budget of €22 billion a year, the highest ever on a per capita basis.

There has been expansion in terms of making healthcare more affordable. For example, in the past couple of years, we have reduced prescription charges for those with medical cards as well as those who do not. We have introduced free GP care for children aged under six on a universal basis. We are bringing in free contraception later in the year. This is very much a programme that is being pursued by the Government.

We have 1,700 more nurses than we had at the beginning of the pandemic. We have a struggle recruiting and retaining staff, as does almost every health service in the world, but it is not a surprise that we should have to deal with that when we are expanding so fast. Many more posts are being created and many more beds are being added to the system. New hospitals are being built all of the time. We are making a lot of progress in that regard. We have a lot more to do, and I acknowledge that.

I acknowledge that. It is good for a society to have more capacity, beds and staff. It still does not answer my question of why more than 50% of people in Ireland have private health insurance. In general, people want good healthcare, whether private or public. The sentiments and patterns across the world are a public, universal one-tier health service such as exists in Britain under the NHS. The outcomes for everybody are really good when there is a health system from cradle to grave. A creeping privatisation has always existed in our health system. People are doing very well out of it and are profiteering from it. Does the Government have the stomach to end the two-tier system and instead provide a universal healthcare system?

I believe in universal healthcare in Ireland. As I outlined to the Deputy, it is something I have tried to make a reality in the past couple of years. We continue to work on that. There is a misunderstanding sometimes about how different health service models work around the world. About 10% of people in the United Kingdom have private health insurance. In lots of European countries, almost everyone has health insurance. That is the case in Germany, the Netherlands and France. Different models work in different countries. Unless we outlaw private health insurance entirely, and I think that might be the Deputy's party policy but perhaps not, we will always have people-----

I did not-----

-----with private health insurance. That is the case.

I never said we should outlaw private health insurance.

It is not the case that nobody has private health insurance in the United Kingdom. People do. In fact, a lot of European countries have an insurance-based model and people are either required to have health insurance or there is a system of social health insurance which is run through the health system. The NHS is not the typical model across the European Union. Countries across the EU tend to use insurance-based models. In Australia, which has a very good health service, there is a mixed system like ours.

The Deputy said one thing which is not correct. He said people have better outcomes in the NHS. In Ireland, one is more likely to survive cancer or a stroke, or recover from a heart attack, than in Britain. The idea that the NHS has better outcomes than Ireland is not correct. We have access problems, but we have better outcomes than the NHS.

We have time limits.

Research we in Aontú carried out in recent times found that over 200 children who are known to child protection services have died over the past ten years.

Some 42 children died while in State care and 164 children who were known to child protection services died. Half of the children who died while in State care died either by suicide or by drug overdose. Twelve children were murdered while known to child protection services over the past decade. During the same period, 62 children who were known to child protection services died by suspected suicide. God rest them all. I cannot think of anything more shocking, heartbreaking or tragic than a child committing suicide or a child being murdered, but to think that 12 children were murdered and 62 children took their own lives while under the eyes of the State is incredible. These were children with their full potential and full lives in front of them.

There is a massive crisis happening at present. Last year, 70,000 children were referred to Tusla. That is more than the number of children who started school last year. It is 4% of the population of children in this State, and these are being referred to Tusla every year. The number is increasing, no doubt due to many factors. Of course, the lockdowns over the last 20 months certainly did not help. We heard a powerful contribution last week from Deputy McGuinness regarding the Grace case and today we will discuss the mother and baby homes. I look forward to contributing to that debate to ensure that people and institutions are held to account for the suffering and deaths of vulnerable women and children in the care of the State in the past. It is very important that we get justice for people in the past. However, it is also critical that we have transparency and accountability today. What I have outlined is happening in the Tánaiste's time and under his watch. If we act now, we can have an impact on these lives. We can do something about this right now in real time.

These facts represent an enormous human tragedy. The issue of children being murdered while known to child protection services warrants a full, proper debate in this Chamber. What is being done to reduce the suicide and murder rates among children in State care or known to the child protection services of this country?

I thank the Deputy for raising the important issue of child protection. I realise that we will debate this in the House later and that we will continue to discuss it in the weeks and months ahead. I agree that we must do more to help every child to get the start in life to which the child is entitled. For many children that is very difficult because of the circumstances of their birth or the lack of family support. They just do not get the start in life that they deserve. We have a responsibility to try to make sure they do. It is really sad and tragic that 12 children who were under State care or known to the State were victims of murder. They are individual cases and, in some cases, they are complex, with complicated stories behind that. I know the Deputy is not trying to do this, but I do not believe it is fair to say that Tusla or the State was in some way responsible for that happening. However, we must do everything we can to ensure it does not happen.

The same applies to the very sad number of people in State care who died as a consequence of suicide. Ireland has seen suicide rates fall considerably in recent years. That is, in part, because of the additional investment in mental health, the fact that we have a national suicide prevention strategy that is working well, that we have a national office for suicide prevention and that we have been acting expeditiously in these areas. However, the points raised by the Deputy are valid and I know the Minister for Children, Equality, Disability, Integration and Youth, Deputy O'Gorman, will want to discuss them further.

First, many people who are working in child protection services are doing the best they can under the circumstances they are in, but there are things we can do to fix this. In the first place, there is a major correlation between economic and societal disadvantage and some of these outcomes. As a State, we must lift these communities out of poverty and strengthen those families. There are also specifics. For example, there are no emergency out-of-hours services in any part of the country outside Dublin for child protection. These crises typically do not happen during office hours. There are also major difficulties with getting mental health services to children who need them. There are Irish children who are currently going to Britain for psychiatric services because we do not have the capacity here. There are major problems with addiction services. There is no priority for children in care when it comes to addiction services. There are not enough homelessness services for children who are known to child protection services in this country. There are other issues. The Government has privatised part of the foster care services in the State and some of those outcomes have not been the best. Rather than there being an investigation into this crisis 50 years from now, can the Tánaiste commit to fixing at least the specifics I have raised today?

The Deputy is right in one of the fundamental points he made, that if we can reduce poverty and inequality in our society the number of these difficult issues that arise will be less. He will acknowledge that Ireland is a country in which poverty has been falling in the last five or six years, if not the last ten years. It is a country in which inequality has been narrowing. Some people try to deny that, but it is a fact and the Central Statistics Office's survey on income and living conditions, SILC, confirms that. I am proud to be a member of the Government that has overseen a reduction in poverty and a narrowing of inequality in Ireland over the last period. We want that to continue. We will continue it by pursuing both economic policies that generate wealth and social policies that reduce poverty and narrow inequality.

In terms of the services, I agree that we must invest more in services such as Tusla, homelessness services and others. It is good that we have a dedicated agency in Tusla. We did not have one previously as it was a matter that was left to the HSE. We must continue to invest in Tusla, as we are now and in the next couple of years.