Dáil Éireann díospóireacht -
Tuesday, 26 Sep 2023

Vol. 1042 No. 5

Ceisteanna ó Cheannairí - Leaders' Questions

Deputy Mary Lou McDonald

This morning many crèches across the country closed their doors for three days due to frustration with Government policy. As we speak, and as the Taoiseach knows, providers are now protesting at the gates of the Dáil. Of course, the big losers in this situation are thousands of families who will experience significant disruption this week - parents left in the lurch, seeking alternative childcare arrangements so that they can get out the door to work. The reality is that the provision of childcare services is in crisis and that has been the case for some time. While Government has gone some way, its policy has failed to make the scale of improvement that families are crying out for and for the majority of families, childcare remains just too expensive.

In last year's budget the Government did not go far enough to reduce costs, so we still see parents paying the equivalent of a second mortgage in childcare fees. These massive fees are an incredible financial burden on parents at the best of times, not to mind during the most serious cost-of-living crisis in 40 years.

The chronic lack of childcare spaces is also a serious problem that hits families every year. The capacity crisis is a source of enormous stress for parents right across the country. No parent should be forced to have the hard conversation about whether or not one of them might have to give up work because they have no childcare options.

At the heart of this crisis is the prolonged underinvestment by successive Fianna Fáil and Fine Gael Governments that has pushed childcare services to breaking point, sustained poor levels of pay for childcare professionals and has severely undermined the viability of childcare providers. Tá géarchéim i gcúram leanaí in Éireann faoi láthair. Tá táillí ollmhóra á n-íoc ag tuismitheoirí fós agus bíonn go leor daoine ag streachailt le háiteanna a aimsiú dá bpáistí. Caithfidh an Rialtas infheistíocht a dhéanamh sa bhuiséid chun costas cúraim leanaí a laghdú go suntasach.

The pathway to a fairer, fit-for-purpose childcare sector is greater public investment. It is now clearer than ever that the Government must increase investment, bring down fees dramatically for parents and guarantee fair pay for childcare professionals. This is how the burden can be lifted from families and how we can deliver childcare places to the level required so that no child or family is left behind. Of course, this has to be done in a planned, strategic, incremental manner, but the first step has to be to increase the affordability and accessibility of childcare services. This is essential if we want a modern, agile and resilient economy, if we want to ensure a better quality of life for families and, most importantly, if we want to ensure that every child has the best start in early education. It is time for Government to stop tinkering around the edges of the crisis and step up with real ambition.

Last year, the Government committed to cutting childcare fees by 50% over two budgets. That means an additional cut of 25% in budget 2024. Will the Taoiseach honour that commitment? I put it to him that he should, in fact, go further than that commitment. I also ask him to ensure an urgent resumption of talks to focus efforts on ensuring that childcare professionals get the wages that they deserve. Will the Taoiseach ensure in the budget that whatever necessary finances are required to make that a reality, that the Government will also provide for that?

The Taoiseach

I thank the Deputy for raising this important matter. As she knows, there is a childcare and early years education strike happening today. Of the 4,000 childcare providers in the State, we understand that 5%, or probably fewer, are participating in the action today. That is important to point out. The action is being supported by only one organisation, the Federation of Early Childhood Providers. We acknowledge absolutely that there are real challenges and pressures in the childcare and early education sector. The administrative burden has increased, putting a lot of pressure on the time providers and professionals have to provide their service. Of course, funding for any service is always a challenge. We acknowledge those things too but of course they can be resolved. We believe the best way to resolve them is through co-operation and the early years forum, which the Minister attends and which met as recently as last week. We do not believe this action by one organisation is warranted. It is causing great inconvenience for parents, particularly parent who have had to take time off work or even annual leave to look after their children while the strike by this particular group is under way.

The Government has prioritised investment in childcare like no other. Over €1 billion per year is now being invested in childcare and early-years education. That will, of course, increase for next year in the budget, but this has to be done within the parameters of a 6.2% overall increase in spending, to which I believe the Deputy's party has signed up and agreed. She might clarify whether that is the case.

We have three objectives when it comes to childhood and early-years care in Ireland: to make it more affordable, to make it more available and to ensure that quality and standards improve. We reduced the cost of childcare for the vast majority of parents by roughly 25% last year. I know this has been very welcome and has really helped with many household budgets. We seek to reduce the cost further in the forthcoming budget. We are looking at ways to make it more available. In my constituency and many other parts of the country, getting a place at all can be a big challenge. We are looking at interventions to increase availability over the next couple of years.

We are raising standards and quality all the time. One of the ways we are doing that is by improving the terms and conditions of people who work in the sector. There is now an employment regulation order ensuring there is a salary scale and proper minimum terms and conditions for this sector. About 70% of childcare and early education professionals received a pay increase last year, and I would imagine this will be the case in the year to come. This is an area the Government is committed to and is working on. It is prioritising affordability, availability and quality and we do not think the action that is taking place, which is only supported by a minority of childcare providers, is warranted.

Deputy Mary Lou McDonald

I thank the Taoiseach for that response. Notwithstanding that this is a minority-led dispute, as he says, I am sure he will accept that those concerned do in many ways speak for the entirety of the sector, certainly for an awful lot of families, who still experience childcare costs that are too high or who in many instances experience a complete lack of availability of childcare places. Therefore, issues of affordability and capacity still loom large.

I asked the Taoiseach whether he would honour his commitment to reduce childcare fees by a further 25% in this year's budget. I would like a straight answer to that. I also asked the Taoiseach about the pay for childcare professionals. He indicated correctly that there has been some progress made on this, but I put it to him that if he wants to ensure sustainable capacity, radical change needs to happen in terms of the career paths of childcare professionals and their levels of pay. It is not sufficient to say there are now minimum scales and that we have made minimal improvements; you really have to go at this, and there has to be a resource, a pot of money, provided for in the budget for that also.

The Taoiseach

I thank the Deputy. It remains the Government's objective to reduce the cost of childcare by 50%. We set that out some time ago. We are halfway there already. We also need to invest in capacity because we also need to ensure there are more places available. We also need to invest in quality, and that includes better pay for staff, which of course has to be funded, at least in part, by the public purse.

Exactly how much we can dedicate to each of these three objectives has to be negotiated between now and budget day with the involvement of the concerned Ministers. It would be useful to know, and I appreciate Deputy McDonald might not be able to answer now but perhaps she could at a later date, as to whether Sinn Féin supports this action. Only about 5% or less of the providers in the sector are taking part. Does Sinn Féin think more should? Would the party like to see more parents inconvenienced-----

Deputy Mary Lou McDonald

I would like to see the Government fund the sector.

The Taoiseach

-----by having the groups that are not backing the action doing so?

I know the Deputy will ask many questions between now and budget day about how much money we will spend on various priorities. She might let us know at some point whether Sinn Féin is signing up to the Government's decision, made for good, logical and important long-term economic reasons, not to increase spending by more than 6.2% next year.

Deputy Mary Lou McDonald

Is this questions to the Opposition?

Deputy Ivana Bacik

I welcome the Taoiseach back. My question to him today is who cares for the carers. We in the Labour Party are not sure that his Government appreciates the crisis in care. A protest is currently taking place outside the Dáil by childcare and early years education providers. We all hear all the time from parents, staff and workers in the childcare sector who are being failed. Parents cannot access affordable childcare for their children, staff cannot afford to live on the wages in the sector and children are being failed by this.

It is not only a crisis in childcare. Yesterday, Fórsa, SIPTU and the Irish Nurses and Midwives Organisation, INMO, which represent 5,000 staff in the community and voluntary care sector, all balloted for indefinite strike action from 17 October. Withdrawing labour is no easy decision. It is a last resort, but what other option do workers in this sector have? These are workers who provide a lifeline to Ireland's most vulnerable communities, caring for our homeless, providing disability services and providing support for older people, and they provide these essential services on behalf of the State, on behalf of the Government, yet it has washed its hands of responsibility for them.

It is almost one year since this House debated a Labour Party motion to fund pay rises for workers in section 39 organisations and others in the community and voluntary sector. The Government allowed the motion to pass. It did not oppose it but has done nothing since. Now, creaking services are being held together by staff who are facing another winter of spiralling housing costs with wages that have stagnated. One worker from a section 39 organisation stated that serving and supporting the most vulnerable people in our society makes them very proud but that the Government offer compromises the future of organisations like the one they work in:

Staff turnover is high. Nurses and care staff are leaving every day for better care and conditions in section 38 areas ... is a bitter pill to swallow in the current cost-of-living crisis. Rising inflation, increased interest rates and rising childcare costs are crippling.

That is one person's testimony, but it represents the experience of many in the sector.

Services are suffering as a result. Disability and homelessness services are near collapse. Almost 3,000 people have been forced into emergency accommodation due the Government's failed housing policy. The United Nations has criticised Ireland for potential violations in disability services. Yesterday, the Central Statistics Office, CSO, confirmed that 3,600 sexual offences were reported in the year to this spring. These are official statistics. They understate the scale of the problems. Every family is in some way reliant on the care of community and voluntary workers, yet current Government policy is that the value of workers who support people in homelessness and disability services and through rape crisis and domestic violence, if they work for section 10, 39 or 56 organisations, is somehow less than the value of the equivalent workers who are employed directly by the State to provide the same services.

Playing chicken with community and voluntary workers in the way the Government has done is irresponsible, verging on reckless. My question about these heroic workers who have had no pay rise since 2008 is whether the Government will accept their demands for pay parity and will it apply future public pay sector agreements to community and voluntary service workers? Will it take action on the request in the Labour Party motion that was passed exactly one year ago?

The Taoiseach

I thank the Deputy. The threatened strike by section 39 and section 56 organisations is a matter of real concern, especially to the people who need those services daily, to their families and to their carers. The Government is very aware of the potential inconvenience that could be caused should the strike go ahead. I hope it will not. Much of the work done by these bodies is in the disability sector. The work they do is valuable and I assure the Deputy the Government values it.

It is important to state we are not the employer in this instance and we do not determine pay rates, which vary from organisation to organisation. As we have found with other organisations, they can vary both downwards and, in some cases, upwards, although it is mainly downwards in these cases. We do have a role to play as the funder, however. We are the main funder of these organisations and we accept that responsibility. If these organisations did not exist, their services would have to be provided directly by the State. We acknowledge we have a role to play in resolving this.

An offer has been made, which had three elements: a 5% pay increase, a backdated 3% pay increase, and a commitment to engage with the sector again if and when we have a new public sector pay agreement. We do not have one yet, but we hope to have one in the coming weeks or months. We have given a commitment to holding follow-on talks, as used to happen in the past, in the event there is a new public sector pay deal. That is 5% now, 3% backdated, and a commitment to engage on more in a matter of weeks if and when we have a new public sector pay agreement. That offer was accepted by the community sector, which voted on it. Some 82% voted in favour. Unfortunately, staff were not given a vote. I regret that. The offer is still on the table. I ask the unions involved to at least give consideration to balloting their members on it to see what the outcome of such a ballot would be. If they are not willing to do that, there are mechanisms by which they can engage with the employers and with Government, through the Workplace Relations Commission and Labour Court, which I hope will enable this strike not to happen.

Deputy Ivana Bacik

I am glad the Taoiseach acknowledged the severe impact this action would have on those who are so utterly reliant on the services provided by workers in these organisations, because we are all very conscious of the great impact this proposed strike would have on those who are most reliant on services. Frankly, it is a cop-out for the Taoiseach to say the Government is not the employer here.

Deputy Ged Nash

Hear, hear.

Deputy Ivana Bacik

What the organisations are seeking is a restoration of the link that existed and a clear recognition that these are services provided on behalf of the State. The State is the funder, as the Taoiseach himself has acknowledged. We are simply asking for that recognition and acknowledgment to translate, in a practical sense, to a decent offer of pay and conditions for the workers who are impacted and for the service users who will be impacted. As I have said, we in the Labour Party have consistently raised this issue over many months. My colleague Deputy Duncan Smith raised it in the first weeks following the Dáil's resumption last year. We also brought forward a motion last year. The Government's support for that motion recognises the need to move on this and yet the offer is derisory. It is below the rate of inflation. These are workers who love their jobs. We all know people who work in these services. They care deeply for service users but they are being forced out of the sector in search of better pay and conditions elsewhere. Will the Taoiseach grasp the nettle in advance of 17 October?

The Taoiseach

As I mentioned earlier, a good offer was made and this offer was accepted by people in the community sector when a ballot was held.

Deputy Ged Nash

That is not directly comparable.

Deputy Ivana Bacik

It is a different sector.

The Taoiseach

I appreciate there may be differences but it is important to point out that this offer was accepted in a similar sector. It is a 5% pay increase applying from November, that is, a 5% pay increase being paid within a matter of weeks and before Christmas; an additional 3% backdated to April, which would result in a lump sum payment in this calendar year; and a commitment to engage, as we did in the past, if and when we have a new public sector pay deal. I believe that was a good offer and I am sorry it was not accepted. There is always time to engage before strike action takes place. I acknowledge that, if it does take place, it will have an impact on people who use these services. In the meantime, both Tusla and the HSE have been asked, for obvious reasons, to make contingency plans to make sure a minimum level of essential service continues to be provided should the strike go ahead.

Deputy Paul Murphy

Children with spina bifida have been failed scandalously by this State. Now, their families are faced with the horrifying revelations that some of their children who went through surgeries in Temple Street hospital did not get the care they needed. There were extremely high rates of complications and, most scandalously, three had unlicensed non-medical grade springs inserted into them. I spoke to one of the families over the weekend and it would be fair to say they are in absolute turmoil.

They do not feel listened to so far. This scandal is not only about the actions of one surgeon. It is about a governance process that would allow it to happen, and where this would still be happening if it was not for one brave whistleblower speaking out and a journalist who exposed it in an article on The Ditch. Now we have a second external review, after a first internal review and a first external review, essentially because the first external review did not uncover the use of the springs. It took The Ditch to highlight this.

This review must get it right. The families must be at the heart of the process and their views have to be taken on board. The terms of reference have to be amended to include all CHI children's operations. There must be a spinal surgeon on the external review team. The internal review into spinal operations in Crumlin, which has already taken place, must be published.

I want to focus my question on when the Government knew about it. The Minister for Health, Deputy Stephen Donnelly, has been quoted as saying that his Department only became aware of it in August and I do not understand how that can be the case. On 10 May, I asked a parliamentary question to the Minister asking whether all implants used were appropriately licensed. On 25 May, I got an answer from CHI saying that to the best of its knowledge, all spinal implants were CE approved and licensed appropriately. We now know that this was not the case. Why was the "to the best of our knowledge" there? I asked again in June and got the same answer, without the "to the best of our knowledge".

On 13 July, I asked the Minister for Health how many spring implants had been used in Temple Street hospital, how many had been removed and how many failed in situ. I asked whether they were CE marked and if not, what governance process oversaw and permitted their use. That was on 13 July but that is not all. On 5 July, I asked the Taoiseach about this. I spoke to him in the Dáil about the allegations that unlicensed implants had been used in children. The Taoiseach said to me in response that he did not know about it but said he would "let the Minister, Deputy Stephen Donnelly, know that it was raised in the Chamber and get back to the Deputy". I did not hear anything back from the Taoiseach or the Minister.

What did the Taoiseach do after 5 July? I raised this extremely serious allegation with him. He said that he was going to speak to the Minister for Health. Did he tell the Minister about it and when, and then what action was taken by the Government?

The Taoiseach

At the outset, once again I want to take the opportunity to acknowledge that this is a cause of great anxiety for a lot of parents, families and vulnerable children attending these services. A comprehensive patient safety review and assurance process has been commissioned into the paediatric orthopaedic surgery service, and there is a Medical Council complaint that is currently being considered. An expert from the UK, Mr. Selvadurai Nayagam, has been commissioned to lead an external review following identification of a number of specific clinical and patient safety concerns. The concerns related to clinical outcomes of some complex spinal surgery, including what appears to be a higher than normal incidence of post-operative complications and infections, as well as two serious surgical incidents.

It is important to say that we do not have all of the facts yet and therefore it is important that we do not jump to any conclusions at this stage. It is why the Minister for Health and the HSE have sought this external review. It was clear that they did not feel that the existing reports were sufficient and they did not, for example, report the use of these non-CE marked metal springs. It is a matter of concern that this did not come up in the two reviews that were done and which have now been published. As the Deputy knows, two reports, internal and external, have been commissioned. The Minister and chief executive of the HSE made it very clear that the initial position that was adopted by the hospital groups, which was that the reports would not be published, was not acceptable. The Minister for Health will make statements later today and I understand there will also be a joint Oireachtas committee hearing that will allow further discussion of this.

To answer the Deputy's detailed question on when the Government knew, if by "the Government" he means the Cabinet, there has been no Cabinet memo on this so far. There may be one forthcoming. I cannot answer definite questions about timelines within the HSE or the Department of Health but I am sure they can. On the issue the Deputy raised with me, I will have to check. Our standard practice, when something is raised with me in this Chamber on any given day - and many things are - is that it is then passed on to the relevant Minister for a reply.

The Deputy asks a fair question. I first heard definitively about non-medical devices being used in surgery in the past week or so and was shocked.

Deputy Paul Murphy

I told the Taoiseach on 5 July.

The Taoiseach

The Deputy did not pass on any detail or information or at least did not pass it to me. Perhaps he did pass it to other people. If he had that kind of information weeks and months ago, and perhaps he did not, he should have passed it on.

Deputy Paul Murphy

I heard the allegation that unlicensed implants were being used in April so I did what was appropriate and asked the Minister if it was happening. The response I got twice from CHI stated it was not happening. I went back to the person who was alleging this to me with more specifics. I came forward with specific parliamentary questions on 13 July about how many spring implants had been used, how many had been removed, how many had failed in situ and so on. At the very latest, the Government or the Minister knew about the issue on 13 July. That is at the very latest. What does the Government do at that point? It does not make sense that the external review did not uncover the use of springs because there is a reference to springs in the internal review. It states it right there. I have checked. There is no legitimate authorised use of springs for these sorts of surgeons. The reference to springs in the internal review should have caused alarm bells to go off in terms of the external review and should have ensured this was investigated.

I want a commitment from the Taoiseach that the external review that is now going to be done will be done properly, which means expanding it to include all CHI operations.

An Ceann Comhairle

I thank the Deputy. We are over time.

Deputy Paul Murphy

It means there is a spinal surgeon-----

An Ceann Comhairle

Thank you. We are way over time now.

Deputy Paul Murphy

-----involved in the external review. The Taoiseach can see how it is important that I raised the matter with him on 5 July.

An Ceann Comhairle

The Deputy is over time.

Deputy Paul Murphy

He is now saying the normal practice would be to pass that on to the Minister-----

An Ceann Comhairle

The Deputy is over time.

Deputy Paul Murphy

-----and the Minister says he did not know about it until August.

The Taoiseach

My understanding is that parliamentary questions were submitted in the Deputy's name in July. The Department of Health was not aware of this at the time and passed on the queries to the HSE. That was how the issue came to light. The allegations were passed on by the Deputy by means of the parliamentary questions. That information was passed on to the HSE. It made inquiries and that was how the information came to light. I do not want to give exact dates because I do not know them for certain and do not want to mislead the Dáil inadvertently.

We will certainly take on board any suggestions that people have in respect of the review. It is important we get it right. If we were to extend the review to deal with all surgery happening at all three sites, it would take a very long time. We are talking appendixes and minor surgery. I am not sure if that is the right approach. This is about spinal surgery and, as far as we know, one surgeon. If we were to expand it out to every surgery done by every surgeon in all three major paediatric hospitals, we would not be coming back here with an answer for years and I am not sure that would be the best approach but of course I am not going to rule it out at this point. Having discussed the issue with the Minister, Deputy Stephen Donnelly, yesterday, I have issued an invitation to the advocacy groups to meet us later in the week. There are four and possibly five such groups so it will require some logistical work to get it right. However, I am keen to meet them all together. I am keen to hear what they have to say about the issue and we will take that on board before making any decisions.

Deputy Michael Lowry

I wish to address the Taoiseach directly regarding the plight of those with special needs, their families and carers in Tipperary and across the country. Many of them feel forgotten and alone in coping with relentless pressure. We are all familiar with the infamous quote by Mahatma Gandhi, "A nation's greatness is measured by how it treats its weakest members." In today's world, this greatness is calculated by recognising and hearing the pleas of the most vulnerable, especially those who struggle to have their voices heard. As a country, we have disregarded the voices of children and young adults with special needs. We have failed to hear the urgent pleas from their parents. We have glossed over the calls for additional support from their teachers.

A recent Sunday Independent article, aptly titled "Who cares?", summarised the report compiled by the special needs schools and parents group. The contents provided a harrowing glimpse into the lives of families living with a member who has special needs and included families who are struggling every day to cope.

These are families who are made to feel broken. Parents are relying on antidepressants to help them through the day. A mother says that she loves her son but pleads for support as she reluctantly admits that she is afraid of him. Mothers and fathers are neglecting their own healthcare as they cannot leave their children to go for treatment. Parents and families are crying out for help and begging for the support which they so clearly need but cannot get.

Reading this graphic report demonstrates the damaging impact that a lack of proper services is having in homes right across the country every single day. The report spelt out a catalogue of failures in the provision of basic and proper services to those who need them most. The HSE says that it is committed to prioritising the needs of children with special needs. It states that its vision is underpinned by the core values of care, compassion, trust and learning. If so, why are families of special needs children and young adults at breaking point? Where is the care and compassion?

In the context of this budget, we must come to their aid. They are desperate for help. These families shower love and attention on their special ones. They see their beauty and their unfulfilled potential. They become disillusioned and demoralised as they know that with better support structures and services; the quality of life for the child and care could be greatly enhanced.

I inform the Taoiseach that this is an issue of social justice. The workload and strain of home life means that parents are restricted, confined and are left on the margins of society. I therefore ask the Taoiseach to provide significant and substantial Government intervention in the forthcoming budget,

The Taoiseach

I thank Deputy Lowry for raising this very important issue and I know all of us from our own constituency work will have met many parents of very many children who have special educational needs. Investing in special education is the right thing to do to give those children the best possible start in life and that is the objective which all of us in this Chamber share.

It is an area which has seen a great deal of Government investment in recent years and for every four euro we now spend on education, one euro is spent on special needs and special education, which was not the case in the recent past. That is a big change and is an area in which there has been a great deal of investment. To give some numbers on that, there are now almost 3,000 special classes nationwide, of which 1,300 only opened in the past four years. That gives a sense of the significant expansion in special education which has happened in the past couple of years. We also have additional special schools, including in my own constituency but, of course, as will be the case in the run-up to the budget, we will look at all of these areas and I am sure there will be an increased allocation both for education and for special needs within that. The exact amounts will not be agreed until budget day.

Deputy Michael Lowry

There have been endless calls also from parents for the reintroduction of the summer programme for children with special needs. These programmes provide a continuation of daily routines which help children to feel more secure. They ensure consistency and help, which provide stability. For children with special needs, the provision of this stability cannot be overstated. A lack of routine and structure can lead to serious regression, which can impact social skills, behavioural skills and even communication skills. Summer programmes can be a lifesaver for parents. When their child maintains an active routine, care at home can be much more manageable and much less stressful.

The recruitment and retention of therapists to children's disability network teams, CDNTs, is completely vital. If schools were supported and resourced properly throughout the year, there would be far better outcomes for children and families and more schools would be able to offer summer programmes.

Finally, we also need to address the very significant shortage of respite and residential services, which compounds the challenges for these families.

The Taoiseach

I thank the Deputy. The summer programme has expanded significantly in the past three years and almost €40 million is provided now for it, which is double the funding from when this Government took up office in 2020. The summer programme for 2023 was available to all schools that wished to run it.

There was 50% increase in the number of special schools that participated in the school programme. The main priority for this year, in the summer just gone by, was that those children with the most complex educational needs especially in special schools should have access to a school-based summer programme. The Department of Education has already commenced planning for 2024 in the hope that more schools will participate and I encourage them to do so.

I am also informed the progressing disability services, PDS, roadmap for children's disabilities and the disability action plan will be published in the next few weeks. That roadmap focuses on increasing staffing and also using innovation in the CDNTs. There will be new therapist grades. Therapy roles will be listed in the critical skills for people seeking work permits. There will be sponsorship of master's conversion programmes. The Minister, Deputy O'Gorman, the Minister of State, Deputy Rabbitte, and the Minister, Deputy Harris, are engaging on additional CAO places for therapists in particular so that we can train more and have more coming through the system.