Deputy Doherty and I were here last Tuesday, and no notification was given that the Minister for Health would not be present. We asked that the matter be deferred. That is a whole week. We fully expected the Minister to be present. He is aware of the crisis at Letterkenny University Hospital. He knows that 78 GPs have cosigned a letter. He knows that 11 consultants have cosigned a letter. He knows they have asked him to urgently come to County Donegal to meet them. These are front-line health professionals. He has not indicated he is coming to Donegal. He said today that he would come to Donegal in due course. He cannot even come into the Chamber. The utmost disrespect is being shown to the people of Donegal. Here we are, for the second Tuesday in a row and we do not have the Minister. We have no indication whether he will be in Letterkenny any time soon. We will bring our Sinn Féin health spokesperson, Deputy Cullinane, to Letterkenny University Hospital this coming Thursday. He will show the necessary respect. He will meet with the GPs and consultants and listen to their concerns. They are calling for an urgent independent external review, not just of the emergency department operation, but of the entire operation of the hospital, including the chronic underfunding of the hospital and the discrimination against the hospital. Letterkenny University Hospital is the sixth largest in the State. It had 26,000 inpatients last year. This is a major hospital that is chronically underfunded. Whenever there are consultants who have ambition and drive to develop new specialities, they are undermined, held back and curtailed. We salute the stand they have taken. We demand respect from the Minister as soon as possible.
Saincheisteanna Tráthúla - Topical Issue Debate
Hospital Investigations
I can only add to what Deputy Mac Lochlainn said. It smacks of arrogance that the Minister, for two weeks in a row, has decided not to come before the Dáil and listen to what Deputy Mac Lochlainn and I have to say. It is not arrogance towards me or the Deputy. It is to the people of Donegal. It is to the people who tomorrow morning will still be in chairs or on trolleys in the accident and emergency department in Letterkenny. It is the people who have received notification over the past while that their treatment is being postponed once again. It is the people who are wondering if they will ever get the appointment they need to see the consultant to deal with an ailment that could have serious impacts on their health. It is those people that the Minister has affronted tonight. As Deputy Mac Lochlainn said, there are serious with Letterkenny University Hospital. We have both been on our feet over the years explaining to Government after Government that there is a serious systemic issue with that hospital. Deputy Mac Lochlainn pointed out, as he has regularly, that Letterkenny University Hospital is one of the busiest in terms of inpatients. It is the sixth busiest in the State, yet in terms of funding we are the 12th. There is discrimination at the heart of this. We have said, time and again, that this hospital is being kept together with elastic bands and the goodwill of the staff but, bit by bit, they are snapping. They are snapping to the point where 78 GPs across the county had to come together and tell the Minister clearly that there are serious issues and there could be service collapse. Some 11 of the consultants have stood out and put their names to the letter and said there are serious issues. Still, as we stand here, unless the Minister of State tells us differently, we still do not know, weeks on, whether the Minister will come to Donegal and listen to those front-line health professionals. We have serious issues. We had a situation last week where no ambulance was available anywhere in the county because they were all parked at Letterkenny University Hospital and could not offload patients. There are serious issues. These issues are not just about inconvenience to people. As the doctors pointed out, when there is a delay in treatment, it causes adverse health effects, including death.
I assume it is appropriate for me to answer on behalf of the Minister, Deputy Donnelly.
We are going ahead with the Topical Issue matter.
I welcome the opportunity to address the House on this important issue raised by the Deputies. The Government and the Minister are committed to the ongoing development of regional hospitals, such as Letterkenny University Hospital. Letterkenny is a large, busy hospital and the Government has allocated significant resources to meet the needs of patients using the hospital. There were more than 43,000 attendances at the emergency department in Letterkenny in 2022, an increase of 13% compared with 2019. There continues to be a high level of emergency department presentations in 2023, with more than 40,000 attendances between January and September. This represents a 25% increase in overall numbers compared to the same period in 2019 and, more importantly, the attendance figures for patients aged 75 or over is in excess of 6,200, an increase of 1,100 compared to 2019. Following a meeting between the Minister and the HSE CEO last week, it has been agreed that officials from the performance management and improvement unit will travel to Letterkenny this week to visit the hospital.
The improvement of emergency department waiting times is a priority of the Minister and Department, and reform of service delivery across the entire health system is a key part of achieving this. Improvement in patient flow in acute hospitals can be achieved by reducing unnecessary attendances and improving discharge supports. Expansion of community care and other measures to provide people the care they need outside of the emergency department can improve this patient flow and allow our emergency department resources to be better utilised, delivering care to those most urgently in need.
The budget for the hospital has increased from €142 million in 2019 to almost €178 million in 2023, an increase of just under 25%. As of April 2023, 2,144 whole-time equivalents were employed by Letterkenny University Hospital, an increase of over 20% since 2020.
A National Ambulance Service-led service called Pathfinder went live in Letterkenny in April. Pathfinder is designed to safely keep older people who phone 112 or 999 in their own home, rather than taking them to a hospital emergency department. It improves outcomes for older people by providing safe alternative care at home rather than in hospital.
There has been significant investment in services in Letterkenny University Hospital in recent years. Capital projects completed in the past two years include the expansion of gynaecology services; the opening of the acute stroke unit; the provision of an additional endoscopy theatre and a new maternity theatre; and the provision of additional patient beds. There are several capital projects under way which will add additional capacity in services for patients. Projects planned and under way include the expansion of the renal department, the expansion of the oncology day unit and the electrical infrastructure upgrade.
As part of last year’s national winter plan, there was a bespoke site-level plan for Letterkenny University Hospital. While the winter plan officially ended at the end of last winter, many of the plan initiatives continue to be implemented. The Minister asked the HSE to develop a new approach to urgent and emergency care, UEC, planning to reflect the year-round demands on emergency departments, including in Letterkenny University Hospital. The approach to UEC planning is twofold. First, an operational plan for UEC for 2023, which was approved by the Government in July, will be delivered and, second, a three-year multi-annual UEC plan is expected to be submitted to Government later this year.
It is extraordinary there is no commitment in the response from the Minister as to when he will come to Letterkenny University Hospital to meet with the GPs and consultants. There is no acknowledgement that the hospital has been chronically underfunded in that it is a model 3 hospital but had more inpatients in 2022 than five model 4 hospitals. It should be a model 4 hospital. We have talked about the surgical hub that is needed for Letterkenny and Sligo. Given that such hubs have been announced for regions below the infamous line running from Galway across to Dublin, which everybody is aware of, we are being treated as second-class citizens. The Minister's statement does not reflect reality or any sense of urgency.
I appeal to the Minister of State to convey to her colleague that he should have been here tonight in person, that he has shown disrespect to the people of Donegal and that he needs to get up to Donegal urgently.
Speaking on local radio, Highland Radio, last week, one of the consultants at Letterkenny University Hospital stated the hospital has five intensive care beds, which is probably the number we needed about 20 years ago. A report done nearly a decade ago stated we needed over double that, yet that is still the position. The consultant explained what that means. When somebody is in a ward, their health is deteriorating and they need intensive care, they cannot get it in Letterkenny University Hospital. It is not just about inconvenience. People die as a result of not having the proper and adequate resources in our hospitals.
The Minister of State spoke about the solution without even talking to the GPs or consultants because the Minister will not come into the House or go to Donegal to listen to what they have to say. The Minister of State said the performance management and improvement unit will be sent, which is established 24-7 and is supposed to be helping these hospitals in the first instance anyway. This is a permanent unit which is supposed to help Letterkenny, Limerick and other hospitals. What about the nearly 90 beds we need in Letterkenny University Hospital? The Minister announced 1,500 beds three times this year, yet he is not funding these beds in Letterkenny.
Following a meeting between the Minister and the HSE CEO last week, it has been agreed that the performance management and improvement unit is to travel to Letterkenny University Hospital this week. The Minister has offered to meet with representatives of GPs working in County Donegal in the coming weeks, and he also hopes to visit Donegal in the near future. Saolta has advised that will continue to engage with consultants in Letterkenny University Hospital on an ongoing basis. Saolta management has recently written to GPs in the region and extended an offer to meet and discuss the issues of concern.
God almighty, they want to meet the Minister.
They want to meet the Minister.
Flood Risk Management
I will not waste my time in describing what happened last week. Images and videos shared across social media depicted exactly what happened. I will highlight the difficulties around Glashaboy in particular, where a flood relief scheme has just commenced in my home town of Glanmire, as well as in Blackpool, where there has been a persistent hold-up in relation to the flood relief scheme.
The Glashaboy scheme in Glanmire is a 32-month contract and we are only four months into it. Many of the areas flooded along the Glashaboy river will be the last areas raised and those works will come towards the end of the scheme. I ask the Minister of State to relay to the Office of Public Works and Department that they need to analyse the scheme as it is and front-load any mitigation measures they can take in the worst affected areas, such as Copper Valley Vue estate, the new line road in Glantane and Factory Hill in Glanmire. They need to prioritise those worst affected areas. Given what we experienced last week, people cannot wait two years for the scheme to get to those areas.
Midleton town and other parts of east Cork have experienced utter devastation over the past while. I have never seen the likes of it. Hundreds of homes, businesses and roads were destroyed. The bridge in Water-rock and Moore’s bridge need to be replaced. Walls have been knocked down. In Gleann Fia, Mogeely, 30 houses were ruined. Killeagh, Youghal, Castlemartyr, Rathcormack and Midleton were affected. Estates in Midleton, including Willowbank, Tir Cluain, Beechwood, Banoge and Water-rock, were damaged, beyond repair in many instances.
I welcome the announcements today. I welcome the fact so many Ministers and the Taoiseach and Tánaiste came down so quickly but many things need to be discussed and addressed. The community spirit shown by the Garda, the Army, council workers, Civil Defence, the Coast Guard and locals was fantastic. The HSE was fantastic. This cannot happen again. That is why I call for the scheme to be expedited as much as possible. There is huge concern and worry the flooding might happen again and that cannot be allowed.
I join my constituency colleague, Deputy Stanton, and my neighbour, Deputy O’Sullivan, in their words on the devastation in east Cork and the Minister of State’s area of west Waterford. It caused hundreds of millions worth of damage. We have a hospital and a Garda station destroyed. Hundreds of homes are flooded. Midleton Main Street is devastated. In Mogeely, Killeagh, my home parish and community, Inch, Castlemartyr, Ladysbridge, Whitegate, Rathcormack and Cloyne, millions of euro of damage has been done to public infrastructure, homes and businesses.
It is a great shame I only have 90 seconds to advocate for those people in Dáil Éireann tonight but in that limited time, I beg the Government to do everything it can. I welcome the news from Cabinet today and we appreciate the support the Government has given to date.
Other matters need to be dealt with, including flood relief schemes. The schemes in Rathcormac and Midleton are pretty advanced and will need to be expedited urgently for them to be completed. This is something we need to do to prevent those communities from experiencing this devastation again. In other areas, there is great urgency for emergency funds to be allocated for road and transport links.
Cork is very well represented here with four Deputies in the House. I thank them for their comments. In fairness to them, they have advocated for their constituents since the flooding happened last week. I also thank them for acknowledging that we have had similar situations in Clashmore, Tallow and Kinsalebeg in west Waterford,. I visited houses last Friday. It is devastating to see the damage that has been caused.
To try to answer the questions, in regard to the Glashaboy flood relief scheme, as Deputy O'Sullivan will be aware, the scheme was confirmed in January 2021 by the Minister for Public Expenditure, National Plan Delivery and Reform. The scheme, when completed, will provide flood protection to 103 properties, comprising 78 residential and 25 commercial properties. It will address the flood risk in a number of locations in the Glanmire area. The scheme will include defences such as walls and embankments, culvert upgrades, channel widening and road regrading.
In April 2023, Cork City Council, following a successful tender completion, awarded the civil works contract to Sorensen Civil Engineering. In July, it mobilised on site and carried out site investigation works, working with utility providers to agree diversions and engage with stakeholders with works commencing on site at Cuil Chluthair and Springmount. I take on board the points the Deputies made regarding front-loading work in the worst affected areas.
The construction programme is anticipated to take 32 months, with the work split into several zones to minimise disruption to the public and businesses. Following the events of Storm Babet last week, the design team will examine the proposed works through the Glashaboy flood relief scheme to consider whether any short-term or other interventions or mitigations can be beneficially proposed in addition to the approved works.
In east Cork, Cork County Council is now turning its focus to recovery and is beginning the assessment of the wider impact of the floodwaters on rural roads and infrastructure in the hinterland of Midleton and Youghal where local primary and secondary roads have been badly impacted. This will allow a clear picture to develop of the estimated cost of the appropriate works to make the worst affected sections of the road network safe.
In Midleton, the immediate focus will be to evaluate what temporary interim flood defences can be put in place as a bridging measure prior to the implementation of the planned Midleton flood relief scheme structures. The Midleton flood plan will be reviewed following the recent experience and updated to reflect the new risk areas that have been identified. Additional river and water level gauges will be installed and the council will seek to use automated water level threshold alarms to put technology to best effect.
A co-ordination centre was established at Midleton fire station to house the interagency co-ordination team that co-ordinated the local response and evacuation of people trapped by the extreme floodwaters. People displaced by the floodwaters were given shelter at the local hotel and temporary rest centres in Midleton, as Deputies know. Much of Midleton experienced power outages during Storm Babet and ESB crews have restored power to affected areas.
Regarding Midleton Community Hospital, as Deputies know, it was flooded and as a precaution some patients were evacuated to Heather House on St. Mary's campus in Cork city on Wednesday afternoon. The remainder of the main hospital building remained operational on backup generation power until power was restored last Wednesday. A decision was taken to decant the remainder of the hospital patients to Heather House and the National Ambulance Service co-ordinated their transfer. Thankfully, the floodwaters have receded and local authority workers have mobilised to clear debris from affected roads and premises.
I appreciate the response. In a way, we in Glanmire are lucky in that the schemes have commenced. Unfortunately, I cannot say the same for my colleagues in east Cork who are still waiting on the Midleton scheme. That said, as the Minister of State acknowledged in her response, her constituency was impacted. I know she will take what she has experienced over the past week back to the Ministers concerned. I again stress the urgency of the situation. Businesses and livelihoods have been lost. Family homes have been destroyed. We need to have an open debate here on insurance. Mallow was protected. Fermoy had a flood scheme that protected it, as did Douglas. Many of the houses and businesses in these areas still struggle to get insurance against flooding. That is another issue the Minister of State needs to take back to Cabinet and focus on in the time ahead.
I again thank the Minister for her response and acknowledge the Cabinet decision today and all of the work that has been done, but there is more to be done. Hundreds of cars were destroyed beyond use on streets and in garages. One man told me that he could have lost €800,000 worth of stock. We need to start thinking about that. Midleton needs to be underwritten because, as my colleague has said, insurance is not possible due to floods. People are excluded from flood claims.
We need an early warning system because this could happen again. If there was a warning system in place, a lot of the damage could have been avoided. Why was an early warning system not in place? We need an early warning system to let people know what is coming so that they can get stuff out of the way quickly. People have been psychologically impacted by what has happened. We need counselling services in place as soon as possible. A hub in Midleton has called for that. If that could be done, it would be a great help.
I support Deputy Stanton. We have worked in tandem on having a one-stop shop service to help households and businesses that have been flooded. We need the Department of Social Protection to work with the local authorities and other State agencies, which will be needed to get houses back up and running. I thank the emergency services, volunteers and community around east Cork. What they have done is phenomenal. Our Defence Forces, community welfare officers and charitable organisations are working in the area to help households and businesses. All three of us, along with the Minister of State, are indebted to them for their work and we thank them.
I thank the three Deputies. I join with them in thanking the emergency services and all those who stood up in the past week and helped so many businesses and families during what has been a most awful and devastating time.
As the Deputies know, today the Government announced an emergency flood relief scheme to provide aid to businesses and community, voluntary and sporting bodies directly affected by the recent weather events in counties Cork, Waterford, Limerick, Louth and Kilkenny. A second enhanced scheme will allow for higher levels of financial support due to the fact that the impact has been more severe. The scheme will provide a contribution towards the cost of returning businesses premises and community, voluntary and sporting bodies to their pre-flood condition, including the replacement of flooring, fixtures and fittings and damaged stock. The Red Cross will administer these schemes on behalf of the Department of Enterprise, Trade and Employment.
The first stage of application will commence immediately and provide a contribution of up to €5,000 depending on the scale of damage incurred, with the intention to process payments as speedily as possible through the local authorities. To access enhanced payments, applicants will need to go through a more detailed assessment process, including a physical inspection, with the total level of support available at both stages capped at €20,000.
The enhanced emergency business flooding scheme will have an enhanced initial payment of €10,000 and a maximum support level of €100,000, subject to an assessment of the damages caused. A second payment of up to €100,000 will require a more detailed assessment, including physical inspection and will be subject to spot checks and possible audit at a later date.
In addition to the flooding schemes, financial assistance by way of low cost loans is immediately available from Microfinance Ireland. Small businesses can get loan financing from other lenders. Loan options include cash flow loans of up to €25,000, which can be used for general business purposes, including restocking and other business costs. Loans for capital expenditures are also available to fund the refurbishment of premises or the replacement of equipment damaged by the floods.
Early Childhood Care and Education
This is nothing personal, but I am disappointed. The Minister of State has responsibility for mental health and the elderly. My question relates to the Department of Children, Equality, Disability, Integration and Youth and it is probably no wonder that the Minister, Deputy Roderic O'Gorman, is not present given the respect he has shown to date for people in early childcare. The way they have been treated is shocking and it obvious that is why he not showing his face today. It is painful for me to be before the Minister of State, pleading with her to save early years childcare providers.
Providers have received little or no support from this Fine Gael, Fianna Fáil and Green Party Government. The early childcare providers and I appealed to the Minister for an exact breakdown of all expenditure from the Department to funding recipients. The Minister has ducked and weaved and has not given this exact breakdown. However, every effort has been made to destroy the private early childcare providers, putting them out of business in west Cork and elsewhere.
The Department is demanding a validated financial return which must be submitted by an accountant from a registered practice or a registered professional body. This is now an added cost of thousands of euro for early childcare providers.
In her reply, I ask the Minister of State to tell me where she thinks these broke and almost broke providers can find these thousands of euro to do up these accounts. It is shocking that the Department cannot account for its own expenditure when continuously asked, but chases early childcare providers to see where they bought every rubber, pencil and topper.
The Minister treats all these providers with contempt, as does our Taoiseach. I have addressed questions to him in the Dáil and this Fine Gael leader kept answering me by saying it was the parents and the childcare providers who were inconveniencing everybody due to their strike instead of showing some sympathy to them.
The parents support these early childcare providers. They were with them outside Leinster House. They know somebody out there is siphoning money but it is not the private early childcare workers.
The Minister is standing idly by as they go out of business and his Fianna Fáil, Fine Gael and Green Party colleagues are backing him on his way to destroying these top-class providers. They feel the ratio of two adults to 22 children for ECC must be re-examined and a third staff member appropriately funded as children of aged two years and eight months are eligible for the scheme. It seems to the public that there is not a clear understanding of children in the Department at this time. There is simply no clear understanding of children full stop.
Have the Minister or Government members ever attended a public meeting held by the early childcare providers? I have and it was gobsmacking to hear the stories. Does the Minister realise they turn up in huge numbers and tell how they have to turn to their husbands or partners to keep their businesses open? When I hear the way these dedicated people, mainly women, are treated, it makes me and others ask what the hell is going on behind the scenes here.
I ask the Minister to be honest. Who is he protecting and who is wagging the tail here while genuine people go out of business. The Minister pretends to turn a blind eye. His colleagues in Fianna Fáil and Fine Gael turn a blind eye, hoping these businesses will close and be gone out of sight.
I will tell the Minister and his buddies in government that the early preschool providers are waiting for the next election. The parents of the children who are minded by these great people are waiting for the next election. The husbands, partners, parents and family members giving these great people loans so that they can survive are waiting until the next election. They will not forget how the Government treated thousands of them.
Only a few weeks ago they gathered in their thousands outside Leinster House and outside city hall in a peaceful protest. This week, on Thursday, they will hold another peaceful process by holding an awareness day. They will all wear orange and get signatures for their petition. After this, the clock starts ticking, and ticking fast, as there will be an all-out strike in January. All this is due to inactivity and no awareness as to how the sector is being so shockingly treated.
I thank Deputy Collins for raising this issue and for offering the opportunity to respond, in particular to provide an update on the threat of closures of early learning and childcare services on Thursday, 26 October.
Following a meeting between the Minister, Deputy O’Gorman, and the Federation of Early Childhood Providers, FECP, on 18 October, the Minister has been notified that these closures will now not go ahead. He welcomes this development, given the impact closures have on children and their families. With State funding in early learning and childcare at an all-time high, and set to reach €1.109 billion in 2024, the Minister and Government have demonstrated a strong track record in this policy area.
This funding is delivering two years of free preschool education to all children through the Early Childhood Care and Education, ECCE, programme. It is removing barriers to accessing and participating in this programme and in wider early learning and childcare services through the access and inclusion model, AIM, and the new equal participation model, EPM. It is supporting record numbers of families to offset the cost of early learning and childcare through the national childcare scheme, NCS, with the levels of support under that scheme set to increase again in 2024.
Through core funding, it is investing substantially in services to achieve a number of objectives, including affordability, accessibility and quality, as well as sustainability. For year three of the scheme, the allocation will increase by €44 million, or 15%, allowing further progress to be made across all of these objectives. A sum €9.27 million will support a 3% increases in capacity in the sector in year three of the scheme, driven both by new services joining the sector and existing services offering more places and-or longer hours to families.
The allocation for administration will increase by €3.21 million. The allocation for non-staff overheads will increase by €10.07 million to ensure the scheme continues to keep pace with cost pressures facing services. The remaining €21.49 million will be used for other developments, to be informed by the emerging data from year two of the scheme as well as the financial returns.
It is intended that in conjunction with the targeted measures introduced in September 2023, these developments will improve the financial standing of services and will pave the way for further negotiations to improve staff pay and conditions by the Joint Labour Committee, JLC. The Minister is committed to working with the Federation of Early Childhood Providers, FECP, and other stakeholders who can help inform these developments over the coming months.
I thank the Minister of State for her reply. The strike is not going to go ahead on Thursday, but there will be a collection of signatures, petitions and so on. However, the clock is ticking because there is going to be a strike on 1 January. At least now there is a chance for the Minister to wake up to this very serious situation. After the next couple of weeks, the clock will start ticking and there will be an all-out strike in January. All this is due to inactivity and no realisation as to how shockingly treated the sector has been. Doors will not open after Christmas.
The Government has been given ample time to solve this crisis, but it has buried its head in the sand on this issue. Somebody is prompting the Minister, Deputy O'Gorman, onto a road of no return with these early childcare providers. Whoever is doing this has him blinded to what is going on. I plead with the Minister to step back and order the Department to immediately release funds to early childcare providers. The Government is talking about three years' time. This funding is needed immediately by early childcare providers to help them to survive. The Minister should then sit down with the sector and provide fair funding levels for all who provide early childcare.
I meet with many early childcare providers and I have turned up at all the protests they have had. These people are mainly women, although there are a few men, who work very hard and they tell me they have to go to their husbands, their partners or their families to pay the wages or to keep the lights on in their business. There is something wrong somewhere. The Minister seems to be blind to it and seems to be quite happy that they are getting plenty of money. Somebody is getting money, yes, 100%, but we would love to know where it is going. We have pleaded with the Minister continually for a breakdown of the figures but he is walking into a massive all-out shutdown on 1 January if he does not come clean as to where the funding is going.
There has been extensive engagement with the FECP and the Department at ministerial and senior official levels in 2022 and 2023. The federation is represented on the early learning and child care stakeholder forum which met six times in 2022, and three times this year to date. The FECP also participated in the provider representative subgroup of the forum, which focused specifically on core funding in 2022. The subgroup met six times over summer 2022. Furthermore, a technical briefing was also facilitated by the Department on the core funding application process on 4 August, at which representatives of a FECP were in attendance.
Since coming into office, the Minister has met with the FECP on eight occasions, two meetings having taken place this year. There has also been frequent email correspondence and telephone communication and the Deputy will surely agree that is very important to keep the lines of communication open. As well as this, the Minister has committed to developing an action plan for administrative and regulatory simplification. A call for expressions of interest to contribute to this work has issued to representative groups, including the FECP.
To date, more than 93% of eligible providers have now signed up to core funding, with the second year of the scheme in operation since September 2023. I will bring back the Deputy's concerns to the Minister.