Dáil Éireann díospóireacht -
Tuesday, 23 Jan 2024

Vol. 1048 No. 3

Saincheisteanna Tráthúla - Topical Issue Debate

Tax Code

Deputy Christopher O'Sullivan

I thank the Minister of State, Deputy Chambers, for taking this really important Topical Issue matter. The next few weeks and months are crunch time for Ireland's hospitality sector. I do not think there is any doubt about this. We have some very important decisions to make as a Government. We can make decisions that will allow Ireland's hospitality sector to flourish or we can make decisions that will see a continuation of the trends that have seen the closure of hospitality businesses such as cafes and restaurants and the whole sector struggling.

For me, the decision we have to make is very clear. The VAT rate now for hospitality businesses is 13.5%. We need to split that VAT within the sector. Let the accommodation continue at 13.5%. It is okay and can cope with this level. For those food-led businesses and the food-led industry, though, we have to reduce the VAT rate back to where it was before the budget, at 9%. When I talk about food-led businesses, I am talking about cafes and restaurants and those small, family-run hotels that deal almost primarily in food in some instances. I refer as well to the gastropubs. These are the businesses that are the heart of our towns and villages. These are the cafes and restaurants that create the buzz and vibrancy on our main streets. They are run by our friends, neighbours and by family members. If we see this sector struggle and go down the Swanee, then it will be our towns and villages and our communities that will struggle. This is an important point to make.

The thing about this is that many of these businesses are not struggling to fill tables, to fill seats or to get customers in through the door. They are vibrant, have a good product and are serving up really good food, but they cannot make ends meet and cannot make profits. A Government cannot control everything. There is very little we can do, for example, about the cost of ingredients. I refer to the cost of carrots, onions or of a tub of mayonnaise, these important ingredients that this sector uses. There is very little we can do about the escalating cost of energy, for example. There are, however, things we can help with, such as rates. The big lever we can pull, though, is the VAT rate and to reduce it to 9%. This is the single biggest intervention we can make to ensure this sector remains viable and alive.

Some 67% of jobs in rural Ireland are supported by hospitality. That is staggering. It is the biggest indigenous employer. We cannot stand by and see this incredibly important sector, that we are all so passionate about, eroded.

I speak to business owners every day. They are anxious. Many have sleepless nights. I am talking about some of the most successful businesses in my region but the owners are losing sleep because of this issue. We have to intervene and reduce the VAT rate for food-led businesses back to 9% to just give them a chance.

Minister of State at the Department of Transport (Deputy Jack Chambers)

I thank the Deputy. I know how important this issue is generally and in his constituency. I am taking this debate on behalf of the Minister, Deputy Michael McGrath.

At the outset, the Deputy should note that the VAT rating of goods and services is subject to the requirements of EU VAT law, with which Irish VAT law must comply. In general, the EU VAT directive provides that all goods and services are liable to VAT at the standard rate, which is 23% in Ireland, unless they fall within categories of goods and services specified in Annex III of the VAT directive, in respect of which member states may apply a lower rate of VAT. Tourism and hospitality fall within Annex III, thus explaining why they have been subject to these lower rates for a considerable period. The lower VAT rates that apply in this country are 13.5% and 9%.

As the Deputy will be aware, the 9% VAT rate applied on a temporary basis to the hospitality and tourism sectors until 31 August 2023, when it reverted to the 13.5% rate. The 9% rate was introduced on 1 November 2020 in recognition of the fact that the tourism and hospitality sectors were among those most impacted by the public health restrictions put in place throughout the pandemic. Through no fault of their own, bars, hotels and restaurants had to close on multiple occasions in response to the public health crisis.

The economic rationale for a VAT rate reduction at that time, as it was in 2011 when the rate was also reduced to 9%, was to lower consumer prices, thereby encouraging higher demand, more output and an increase in employment. However, it is important to remember that even temporary VAT reductions have a cost to the Exchequer. The estimated cost of the 9% rate for tourism and hospitality from 1 November 2020 to 31 August 2023 was €1.2 billion. This represented a very substantial support from the Government to the hospitality and tourism-related sectors.

As the 9% VAT reduction was considered temporary in nature from the outset, the Department of Finance carried out an economic assessment of it in 2023 to see if there was a case for its continuing application. This assessment considered the macroeconomic backdrop to any extension of the 9% rate, noting that the economy had rebounded strongly from the pandemic and that economic activity was above pre-pandemic levels. The briefing also noted that the reduced rate was both regressive and costly and that this cost represented a transfer from taxpayers to the sector. The Government accepted this economic assessment but, instead of ceasing the 9% rate on 1 March of last year, extended it to 31 August 2023 at an estimated cost of €300 million to strike what it considered an appropriate balance between the cost to public finances and the provision of support for these sectors.

I note the Deputy is specifically seeking that the reduction in the 9% VAT rate would only apply to food items in the hospitality sector. In this regard, Revenue has previously advised that such a separation from accommodation for VAT purposes is possible. However, it has also indicated that there are practical operational concerns in having different VAT rates applying to hotel accommodation and meals given how the sector operates, with various packages ranging from bed and breakfast accommodation through to all-inclusive board and lodging packages.

In addition, a significant concern the Minister for Finance has with this proposal is that the cost from an Exchequer perspective would still be very significant. Food makes up a far greater proportion of overall tourism and hospitality VAT revenue than accommodation. For instance, were the 9% rate to be applied to food for 2024, the estimated cost would be €570 million. Consequently, the Minister for Finance is not in a position to apply a 9% VAT rate to food items in the hospitality sector.

Deputy Christopher O'Sullivan

I am obviously utterly disappointed at the response and at the refusal to even examine this proposal further. There is mention of a cost of €570 million to the Exchequer. That is obviously not be ignored. We cannot pretend it is a small figure. It is a lot; it is €570 million. However, the cost to our communities, to society and to our tourism regions of losing cafes, restaurants and gastropubs on the main streets of our towns and villages is far greater. We know the economy is doing well and that we are at almost zero unemployment but there are other aspects to the economy in different regions that we cannot ignore. While there is a cost of €570 million, I will say again that 67% of jobs in rural Ireland are supported by the hospitality sector. It is the single biggest indigenous employer. I do not see that anywhere in the report or the assessment. I want to see a proper assessment of what this would mean to hospitality businesses, cafes, restaurants, gastropubs and hotels. That is what I want to see rather than a simple figure.

Back in March 2023, I flagged with the Taoiseach that there was a tidal wave coming down the line for the hospitality sector. We cannot help with some of the costs. Auto-enrolment and the increase in the minimum wage had to happen and we are not going to row back on them. There is no way we are going to row back on increased sick leave. The one thing we can fix is the VAT rate. I want to see it examined again. I am not going to give up in my quest to have this sorted. The administrative issues Revenue talks about are a load of baloney. This can happen. It happens in other countries. A rate of 13.5% on hospitality is far greater than the European average. This has to be revisited. I am not accepting the "No" I am getting as an answer today.

Deputy Jack Chambers

I appreciate Deputy O'Sullivan raising this issue and his contributions today. We all know the real importance of the hospitality sector, which is, as the Deputy has stated, a very significant employer across the country, in our cities and towns, as well as in many rural communities. It is a sector where job opportunities exist, ranging from part-time to full-time roles. I am also conscious that it can be a challenging sector to operate within.

The Government obviously wants to maintain a healthy and profitable environment for the sector but, in making any decision on VAT or other taxation measures, the Government must balance the cost of the measures in question with their impact on the overall budgetary framework. I will refer to an initiative of the Minister for Finance, Deputy McGrath. On 17 January, he announced that he has been engaging with the Revenue Commissioners on the development of a proposal to introduce further flexibility to the tax debt warehousing scheme. Further information will be outlined soon but it is the Minister's intention to introduce enhanced flexibility to support viable businesses. To this end, he advised that the Government was looking at issues around repayment arrangements and the interest rate that will apply. Revenue has indicated that it will be flexible as regards payment plans for warehoused debt and will work with businesses in the scheme so that they can secure their viability into the future.

As I have already indicated, the cost of applying the 9% rate to food items in the hospitality sector would amount to €570 million in a full year and €470 million from 1 March of this year to the end of the year. Such a decision would have significant consequences, as it would provide support for some businesses and not others while further limiting the Government's options in the future by reducing the overall budget available for other measures. I will reflect the Deputy's contribution on this Topical Issue to the Minister, Deputy McGrath.

An Leas-Cheann Comhairle

Táimid ag bogadh ar aghaidh go dtí an dara ceist, atá in ainm an Teachta Matt Carthy, who seeks to discuss services for children with disabilities in Cavan and Monaghan.

Deputy Jack Chambers

I am sorry. The Minister of State, Deputy Rabbitte, is coming. Would the Deputy like to wait?

Deputy Matt Carthy

Is Deputy Chambers taking the third Topical Issue?

Deputy Jack Chambers

Yes, but Deputy Rabbitte is coming.

Deputy Matt Carthy

I am happy to swap.

Flood Relief Schemes

Deputy David Stanton

I thank the Ceann Comhairle's office for choosing this Topical Issue this evening and I thank the Minister of State for being here. It is now over three months since Storm Babet, which devastated my part of the country, Cork, and Midleton in particular. The images from the town on the television screen were really frightening. There was water 3 ft or 4 ft high in houses, homes and businesses and cars and roads were destroyed. I acknowledge the Minister of State visited and saw for himself the damage that was done. For many years now, we have been promised a flood relief scheme not only for Midleton, but also for Castlemartyr and Mogeely, which is to the east of Midleton.

Those areas were also impacted. In fact, of the 32 houses in one estate in Mogeely, 30 were destroyed. Everything people had in those new houses was destroyed. There was millions of euro in damage. Not alone that, there was also the heartache, pressure and trouble experienced by those affected.

I know the Minister of State has a prepared script. What has been done since Storm Babet hit on 18 October? Tonight, Storm Jocelyn is battering the country. At the weekend, there was another storm. There are 21 storms in this season. We are now on storm No. 10. They are coming thick and fast, like rosary beads, one after another across the Atlantic. When Storm Isha was hitting us at the weekend I was worried there would be another flood in Midleton. Another downpour is all it will take. We need to expedite the flood defences. What has happened in the past three months in that regard? I have been raising this consistently with my colleagues since that time. I was told a few weeks ago that there is a plan to divert the River Kiltha in Castlemartyr, for instance. What is happening in that regard? There were possible interim plans. What is happening with that? What will happen in Mogeely? I know the major scheme in Midleton town is very complicated and there is a €50 million package available to spend. What is the status of that scheme? What is happening with the planning permission? I understand the plans are ready and a significant amount of work has been done. It now has to go to planning. What route will that take? Will it go the conventional route or the river catchment route?

These are questions people are asking. They are concerned about it. The constant topic of conversation around the town and in the area is what will happen and whether there will be another flood. An elderly man with a disability was taken out of his house in the shovel of a JCB. He told me that every time he hears the rain he is afraid of his life that it will happen again. He does not want to go back to the house.

The situation is beyond urgent at this stage. I know there are two rivers coming into Midleton town, the tide coming in, the caves and the run-off from the land. We were all aghast at the flooding. The Taoiseach, the Tánaiste and many Ministers, including the Minister of State, Deputy Chambers, came down to east Cork in the few days after the flooding but my experience through the many years is that once something has been seen, dealt with and highlighted, it then fades away. I do not want this issue to fade away. I am afraid it will happen again.

We were very lucky that there were no fatalities the last time. Some people were washed down the street. One woman came out of a shop and her feet were taken out from under her, such was the pressure of the water, and she was washed down the street. Another man was in his garden. The wall at the back of the garden collapsed with the force of water. The same happened in one of the housing estates. Walls were blown away by the force of the water. It was unimaginable. At least two bridges I know of need to be replaced. The Minister of State has seen those bridges and some of the roads affected. I understand Cork County Council is in discussion with his Department, namely, the Department of Transport, for roads funding. When will that funding be released? When will we have certainty in that regard? If the Minister of State cannot answer that now, perhaps he will send me a note on it in the next day or two.

Deputy Jack Chambers

I thank the Deputy for raising this important issue. Having visited Midleton following the flooding from Storm Babet, I have seen at first hand the devastating impact flooding has for home owners, businesses and the wider community.

The catchment flood risk assessment and management, CFRAM, programme provided the Government with the evidence to launch a national and proactive programme of 120 additional and new flood relief schemes in 2018. While Midleton was part of this programme, major flooding in December 2015 and again in January 2016 were the catalysts to commence work for the design of a flood relief scheme for Midleton ahead of the conclusion of the CFRAM programme. Cork County Council is leading the design of the scheme and in 2017 appointed engineering and environmental consultants. Designing any flood relief scheme is complex and requires data on the flood sources and their associated risks. Today, some 100 schemes are at design and construction stages.

Midleton has proven to be a more complex scheme. It has flood risks from four sources, namely, fluvial, tidal, groundwater and pluvial. In 2017, data did not exist on all sources and monitoring was required to allow the flooding mechanism to be fully understood. The data gathering and changing regulatory requirements, including environmental assessments, increased the scale and scope of the design project. Throughout this time, three public participation days were held, in 2017, 2020 and 2022. As well as engaging with the local community on the scheme’s progress, these served to gather useful information and assess their views on the emerging option and, more recently, the preferred option for the Midleton flood relief scheme. The outcome also increased the scope of the analysis and assessments required.

The preferred scheme has now been identified, with a total project budget of €50 million, three times that estimated in 2017. This highlights the scale of the project's increase in scope. It also highlights that we have designed a scheme that is robust and supported by strong evidence. It has the support of the community and is future proofed and adaptable to climate change scenarios. The preferred option protects 580 properties against the one in 100 year flood fluvial event, can give back flood insurance to the town and stands up to scrutiny and-or challenge.

Having invested eight years in arriving at a preferred scheme, an assessment following Storm Babet is under way, in order that we know we have a scheme that can meet the standard of protection required by the insurance industry. The next major step is to seek planning consent. Work has already begun on the environmental surveys to allow us to start the planning consent process early this year.

After Storm Babet, the Minister of State, Deputy O’Donovan, and his officials met with the chief executive and senior officials from Cork County Council and the scheme’s consultants to discuss how the Midleton scheme can be delivered as quickly as possible. While the planning stage for this project is due to commence shortly, Cork County Council is assessing Storm Babet to identify the possibility of advancing any viable interim and targeted works for the town. Identification and ongoing roll-out of interim measures has also been progressed, including the removal of trees in channel at Moore’s Bridge and installation of a water level gauge at Tir Cluain bridge, with additional gauges to be installed at Lidl bridge and the pedestrian bridge in People’s Park in January 2024.

East Cork bore some of the worst impacts from this flooding. In Midleton, the Owenacurra river rose at an unprecedented rate and broke its banks at two locations, causing significant flood damage to the town, with more than 100 properties flooded. At its peak, the main street in Midleton saw floodwaters in excess of 1 m depth, requiring the evacuation of dwellings and commercial properties. People displaced by the floodwaters were given shelter.

The OPW and local authorities do not have the powers to expedite the schemes arising from the damage caused by flooding events. The delivery of all schemes must meet all regulatory and planning requirements. Consideration is being given to the preferred planning route that can deliver this scheme as quickly as possible.

In terms of the wider flood risk management scheme, there is a prioritised approach to deliver schemes where work is complete or under way. Under the OPW minor flood mitigation works and coastal protection scheme, applications by local authorities for localised flood mitigation measures are considered for projects that are estimated at a variety of costs, as was outlined to the Deputy previously by the Minister of State, Deputy O'Donovan.

Deputy David Stanton

I thank the Minister of State. As he said, this all started in December 2015, eight years ago. That is a long time ago. Is he satisfied the OPW and the council have enough resources to carry on with the work and the planning and move it on? Do they need more manpower, expertise, engineers or planners to move this forward? He referred to insurance on several occasions. Several of the businesses in question were underinsured, unfortunately. I thank the Department of Enterprise, Trade and Employment and the Red Cross for the work they did with businesses. Some businesses never expected the level of devastation that occurred. No one could have expected it. It was unprecedented. I have been in the shops, houses and businesses affected. It is devastating to see what happened. Some people were insured to a certain level but it went way beyond that. Can the State come in and help those businesses to make up the difference? Thus far, the scheme does not allow for that.

In addition, outdoor infrastructure was damaged in some cases. That is not covered either. The Minister of State referred to this being a one in 100 year event.

Deputy Jack Chambers

The fluvial event was a one in 100 year event.

Deputy David Stanton

I would be very interested to know where that figure came from. Who came up with it? We have had flooding in 2015, 2018 and 2023. I am worried there might be another flood. I do not want to be wandering around the town in my wellingtons, helping people and pulling sandbags. I am getting too old for that. To be serious, this is devastating for the people affected.

The Minister of State referred to insurance. I wish to put on record that some insurance companies have been slow to come forward. I will shortly name those insurance companies in the House if they do not come forward. It is not fair that people whose homes are insured are still waiting for relief, help, support and payments from insurance companies. The companies should be moving to help but some of them are not doing so.

Reference was made to Moore's Bridge. It is a private bridge. We want funding for it.

The same applies to Water Rock bridge, which needs doing, and major work is needed in Mogeely and Castlemartyr.

Deputy Jack Chambers

Cork County Council is working closely with the community during the remaining delivery of this important scheme. In the briefing provided by the OPW and the Minister of State, Deputy O'Donovan, they speak about different types of flood event. I think they reference one particular event having that time period. I take the Deputy's point on the greater frequency that is being seen there. I am not sure what the specific definition of those flood events was. I understand the importance of bringing security and certainty for the wider community who live in fear of the next storm and the next event. There is an obligation on the State and the wider structures of the State to respond properly and with sincerity to make progress in the interests of the communities the Deputy represents and address the concerns he has articulated. I take that point very seriously.

Two meetings have been scheduled recently between the steering group for the scheme and locally elected representatives, businesses and residents. One took place in November of last year and the other is scheduled for this month. The Government is committed to the delivery of a flood relief scheme for Midleton and this will be funded from the €1.3 billion that is available for flood risk management measures under the national development plan. I will raise the wider concerns and points the Deputy has made and the need for absolute focus on delivery and progress on this matter for the people in Midleton.

Regarding the roads, which have been atrociously damaged, I know, there is extensive work ongoing between Cork County Council and the Department of Transport on putting the final estimate together. We will be responding properly so that there are full repairs and restoration of the road network, both local and regional, that was very badly affected during that period and will try to make significant progress on that this year. There is extensive engagement ongoing on that.

Disability Services

Deputy Matt Carthy

I have been raising issues of the lack of services for children with disabilities in County Monaghan since I was elected to this House and, in fact, beforehand. Disability services over my county are sorely lacking. Even the service elected representatives receive is often lacking as well.

There are two issues that I have raised with the Minister of State consistently that I want to put on the record of this House again. The first is in respect of respite services for children with disabilities in County Monaghan, which do not exist. Children in the county have to go onto the waiting list for the services in County Cavan, which themselves only operate every second week for children. The latest figures I have indicate that 33 children receive respite care in Cavan, all of whom are seeking additional hours that they need. There are a further 57 children on waiting lists for respite services and I know of others who have not even applied because they know the service is not available even though it is needed.

Second, there is a need for a special school in County Monaghan. There is a special school in County Cavan but again, there are children in County Monaghan, and I am sure in County Cavan as well, who cannot get access to it because it is full. Earlier this week, I heard the Minister of State, Deputy Rabbitte, speaking on the radio about respite services. I want her to spell out precisely what the plan is for respite services. I heard her mention that the HSE is looking for a building to build or buy, or whatever the case may be. Will the Minister of State outline how much is in the budget this year to provide respite services? These are the same disability services that left a brand new building vacant for years in my home town of Carrickmacross after it had been built. There was a lack of forward planning.

Virtually a year ago, on 17 February 2023, I raised one particular tragic case of a family that are in desperate need of respite services. In fairness to the Minister of State, she was very empathetic and sympathetic and agreed there and then to meet the mother involved. This is a mother who has a child with profound additional needs and all sorts of other things going on. In fairness, the Minister of State held that meeting and there was a senior member of the disability services present. She will remember there was an issue in terms of policy with regard to the services in Cavan. After a number of months, that policy was changed. On successive, countless occasions since then, I have interacted through parliamentary questions with both the Minister of State and the disability services. On 25 September, for example, I got a response from the disability services indicating that, having considered this child's individual needs and in consultation with the child's mother, a plan had been devised to provide day respite hours initially and to gradually increase the duration of the child's visits. The length of these visits would be decided during upcoming meetings with the child's mother and the child. Once they became familiar and comfortable with the respite service at Annalee centre, overnight stays would be introduced. They are essentially blaming the child if they do not get respite care. That was from September 2023. Since then I have made references to the case here in the Dáil. I could not believe it when I spoke to the child's mother at the beginning of this year and she told me that the child still does not have overnight respite. It is a scandal.

I spoke to the Minister of State and, in fairness, she was amenable and answered the call. She told me that within 24 hours, the head of disability services would be in touch with me. I have still not been contacted. How am I supposed to provide representation to a family when we have senior officials that treat elected representatives like that? How can we trust that those officials are treating the families with the respect and dignity they deserve if they are treating us, who have this public platform, in this way? That mother was forced to go onto "Liveline" and local radio to outline the family's case. I ask the Minister of State to tell me when that child is going to have overnight respite care.

Minister of State at the Department of Health (Deputy Anne Rabbitte)

I thank the Deputy for tabling this Topical Issue matter this evening and giving me the opportunity to discuss it on the floor of the Dáil. He quite rightly outlined that he has raised this specific case with me over the last 12 months. Not only that but he and his colleagues in Cavan-Monaghan have continuously raised the issue of the lack of respite services in County Monaghan and the fact that children have to leave the county and share the service on a week on, week off basis with the neighbouring county, with adults one week and children another week.

My script does not reflect what the Deputy has outlined. When the matter was tabled it referred to children's services and the officials automatically assumed that meant everything to do with children's disability network teams, CDNTs. There is no word of respite in the statement I have. I can answer the Deputy's question, however, because I understand it and have been involved in the matter, which relates to the lack of services in an area where children have to leave and share services on a week on, week off basis. I have raised that with disability services. The way community healthcare organisation, CHO, 1 is divvied out, we have Donegal, Sligo-Leitrim and Cavan-Monaghan. That is how the area has always been looked at. It has never been looked at on a county-by-county basis or within the old catchment areas. The Deputy quite rightly said that children have to leave the county and that there are not sufficient or adequate services for them.

The Deputy's first and very clear question was what money I have in the purse. I have enough money in the purse to fund a seven over seven, which is a four- or five-bedroom house that can accommodate four or five children and is compatible, on a seven-night basis, for staffing. It would not be fair for me to indicate the amount of funding I have but it is enough to do that. That equates to approximately 75 children who can be facilitated. I said yesterday on a radio show that the way this needs to be done is through two front doors - a front door for children who have a mild to moderate disability, are compatible and can be with each other. Children who have sensory needs cannot share that space. We do not want a scenario where the service does not function for everybody else. That is where the second front door can operate. I have seen the two front door model used successfully and continuously in Council Clare, for example.

Edel has made a submission to the national office that it go through HSE estates. I am reluctant to deal with HSE estates, to be honest, because the process takes so long. If there was a section 39 provider already providing services in the area, it would be the ideal candidate to say it is able to provide or open to providing the service. It could purchase a property quicker than going through HSE estates. I am not being alarmist, but that process can take four years.

If you purchase a particular house through a section 39 organisation, it can be operationalised very quickly because it will recruit the staff. It is also important to say that there is not an embargo on staffing in disability services. We are slow at the moment in getting that message out there, but there is not an embargo. There is funding available for the Deputy's county. That has been totally laid bare. I wrote down the names of all the people I have met at this stage. I have met Senators Diarmuid Wilson, Robbie Gallagher and Joe O'Reilly, the Minister for Social Protection, Deputy Humphreys, and Deputies Matt Carthy, Niamh Smyth and Brendan Smith. I have met every one of them, and every one of them outlined the need for it, so this is not wasted. As for the lady I met in my office, I can only but apologise for the fact that she is only getting what I would call introductory hours. The reason we use that sort of language is that if a child does not transition comfortably, then they might not want or be able to put their head on a pillow at night. It is unfortunate that it has taken six months for that to progress, to be honest.

Deputy Matt Carthy

It is even longer than six months.

Deputy Anne Rabbitte

I know that.

Deputy Matt Carthy

This particular case is just unacceptable, and heads need to be smacked together. We raised the issue in February and I think it was March when we had the meeting. It took a number of months to get them to change an archaic policy which was unique in respect of the fact that this child was being denied services essentially because of a word on a page. In between times, nothing was being done in terms of even preparing for that. Then the policy was changed. The response I read to the Minister of State is from September. We are now at the end of January 2024. I cannot remember the first time I raised this young man's case in parliamentary questions, but it has to be verging on two years ago at this stage. Therefore, it is important we say that it is not a way to treat human beings, and especially children with disabilities and their families who are at their wits' end.

To be quite frank, if the service in Cavan was good enough there probably would not be the strong demand that there rightfully is in terms of looking for the service in Monaghan. The Cavan service is not good enough. The reason we know that is that everybody who is availing of it needs more hours. There are adults and young adults who cannot get respite because they are basically sharing the alternative weeks. It is not good enough and it is not acceptable. I will not be accepting it anymore. We cannot have the situation continue where we are dealing with parents and running round the houses. Officials are saying they will sort it out when the Minister of State is in the room, and then they do not sort it out.

I ask the Minister of State to comment on the demand for a special school in Monaghan, because clearly there is a demand there for that as well. They are the two demands that are raised with me all the time. I want to raise this particular issue and I ask for the Minister of State's assurance that the child in question is going to be sorted out with overnight respite hours quickly.

Deputy Anne Rabbitte

The Deputy is quite right to say that when we sort out the children's services, there will be adequate services for the adults or the younger adults. One house will be left for adult respite services and we will have a children's respite facility. The capital plan is being launched in the next two or three weeks. Cavan is in the capital plan because of the advocacy that has gone on. We will await its publication to see that through.

On special schools, the Deputy knows as well as I do that I do not have the remit for special schools at all. However, I would advocate that there is a serious need for a special school in the area. That was borne out by the health officials who met with us that day. They were clearly able to tell us that there was such a demand to access special schools, and that children were travelling unbelievable distances on buses to access services. To be honest, it is little wonder that Carrickmacross-----

Deputy Matt Carthy

It is Castleblayney.

Deputy Anne Rabbitte

----or Castleblayney provides phenomenal after-school services. They have been part and parcel of where the Minister for Children, Equality, Disability, Integration and Youth has looked in expanding the access and inclusion model. They are also the reason we have included the alternative respite piece in the budget, whereby children can be facilitated after school as opposed to having to do an overnight. We have that in Castleblayney. They are models and we need to have a suite of measures available when it comes to respite. Children need to be supported outside of term time. They need to be supported in the evenings and in Saturday clubs. That is the whole package for families to feel supported. I will speak to Edel to make sure she speaks to the Deputy.

Hospital Overcrowding

Deputy Maurice Quinlivan

I want to put on the record that I am disappointed the Minister, Deputy Stephen Donnelly, is not here. I understand he sent me an email to say he would not be here, but I would expect somebody from the Department of Health to have been available. I have raised this concern on a number of occasions but at least this time I was told that nobody was coming. It is indicative of the Minister. He is dodging the discussion. In a previous Dáil I had years of conversation with the previous Minister, Deputy Harris, about not turning up for these discussions and debates.

I have been raising the issue of University Hospital Limerick in the Chamber since I was elected for the first time in 2016, and it has got worse and worse. Last year was the worst year ever, with more than 21,000 people on trolleys. Yesterday was the worst day ever, with 132 people on trolleys in University Hospital Limerick. It is an incredible number of people. We can get carried away sometimes when we are talking about numbers and statistics, but these are all people. They are family and people we know. They are relations, neighbours and friends, who are often in distress. The situation needs to be addressed. There needs to be Government intervention. The Minister of State will read out a script. I have probably heard the same script for the past seven years non-stop. We need Government intervention that will do something in the here and now, because the Minister is out of touch.

On 5 January this year, the Minister for Health was on "Morning Ireland" and he advised that there were five or six people waiting in the emergency department and another 36 people were on trolleys in wards. This demonstrated how out of touch he was, because the same day the INMO reported that 96 people were on trolleys in the hospital. The day before the number was 81, and the day before that it was 69. That is far more than the Minister's supposed 41 people. The Minister was quite happy to quote the INMO figures when he was on this side of the House, but now he is trying to distort the figures himself. January 2024 is already worse than the whole of the month of January 2023, and the record will be broken in University Hospital Limerick. As I have said, 132 people were on trolleys in University Hospital Limerick yesterday and 109 people are on trolleys there today.

I do not know if the Minister of State has been to the hospital. It has a new emergency department that opened in 2017, but the issue of capacity has never been dealt with. The reason for the number of people presenting at the hospital is because of the Fianna Fáil decision to close the emergency departments in Ennis, Nenagh and St. John's hospital. We were supposed to get a centre of excellence in Limerick but it was never delivered. That is why we have the ongoing problems.

What does it mean when people are on trolley? As I said, these are people who are deemed to be in need of a bed but there is no bed available to them. There were 21,000 people last year. There were 132 people yesterday and there are 109 people today. It is simply not good enough.

Healthcare assistants and nurses have to work in poor conditions. Recently in Limerick, our health spokesperson, Deputy Cullinane, and I met healthcare workers at the hospital. One told me she had 12 patients at that time. She was totally stressed. She did not want to leave the job because she knew there was nobody else there. There are many vacancies in the department. The Royal College of Emergency Medicine in the UK tells us that if people are waiting more than eight hours in an emergency department, one additional death will occur for every 67 people. I know it is slightly different in England from here, but it is a similar statistic. In January 2023, the BBC, quoting the vice-president of the Royal College of Emergency Medicine, reported that for every 82 patients who wait for more than six hours, there is one associated death. Being treated on a trolley in a hospital hallway is accompanied by at lack of privacy and dignity. It is frightening enough for people to be told they need to stay in a hospital, but having to do so in these conditions is terrible.

As per usual, the Minister for Health is not here. It is simply not good enough. He needs to face up to the fact that there needs to be a serious intervention from Government. The plan it has for the 96-bed unit will deliver 48 beds, believe it or not. It will not be there for a number of years. We are without any plan to deal with the here and now.

Deputy Jack Chambers

I thank Deputy Quinlivan for raising this important issue in the House. The Minister for Health, Deputy Donnelly, is very concerned and conscious of the significant and sustained pressures experienced in University Hospital Limerick.

He is committed to ensuring the appropriate supports are delivered to the hospital. In each of the past two years, there were approximately 80,000 attendances at the ED in Limerick, representing a 12% increase on the pre-Covid figures in 2019. While the number of people presenting to the ED last year was broadly similar to that in 2022, an additional more than 1,000 needed to be admitted. More important, the 2023 attendance figures for patients aged 75 or over increased by 30% compared with 2019, leading to admissions of our elderly patients increasing by 1,600.

Over the past year, alternative care pathways have been enhanced to reduce demand on the ED and better facilitate patient flow. These have included, but are not limited to, the alternative pre-hospital pathway, a new collaboration that commenced in September 2023 between University Hospital Limerick and the National Ambulance Service. It will see definitive care provided in the community to patients who call 999 and will reduce the number of ambulances bringing patients directly to the ED. This involves specialist emergency medicine doctors and ambulance service personnel responding to low-acuity ambulance calls. The team will respond in an ambulance service vehicle to appropriate calls within a 45-minute radius of the ambulance centre in Limerick city. Up to the end of December 2023, this service had seen 245 patients. Of these, 52% of patients were seen via an alternative care pathway and 48% were conveyed to the ED.

Pathfinder is a partnership between the ambulance service and the hospital that was launched in Limerick in October 2022 and recently expanded its geographical area of operations throughout the mid-west. The pathfinder rapid response team responds to low-acuity 999 calls, such as from someone who has experienced a fall at home or is generally unwell. The older person is assessed by both an advanced paramedic and an occupational therapist or a physiotherapist. Up to the end of December 2023, 517 patients had been assessed by the regional pathfinder team, 54% of whom were supported at home without the need to go to the ED.

The geriatric emergency medicine unit at UHL recently expanded to nine treatment bays and to 24-hour operations during weekdays. This unit assesses elderly patients in ED with a view to avoiding unnecessary admission to hospital. Data for 2023 shows that of the 2,007 patients seen in this unit, 1,194 patients, or 59%, were discharged to their home, 240, or 12%, were transferred to a model 2 hospital, such as St John’s Hospital, and 558, or 28%, were admitted to UHL.

The medical assessment unit pathway for 999 patients has been extended to St John’s Hospital. This initiative means all three of the hospital group's medical assessment units can now treat patients referred by GPs, ShannonDoc or paramedics.

Deputy Maurice Quinlivan

I thank the Minister of State for his response, although it is clear not enough is being done in the area. We need to reduce the time people spend both waiting for a hospital bed and in hospitals. Those who are fit and healthy enough to return home should be allowed to do so, but in many cases this is not possible. The health Minister has previously stated that a seven-day-a-week discharge regime will be used and I concur with him on that, but as yet that has not been properly put in place. We must be creative and understand that care within the community can contribute to a reduction in wait times and a reduction in the number of days spent by individual patients on trolleys in UHL. The pathfinder programme to which the Minister of State referred and other community initiatives can help many elderly patients who are forced to present at emergency departments for issues that could and should be attended to at home or within the community. Such treatments lessen the stress on these patients associated with having to be present at the emergency department and improves the capacity of the hospital. Unfortunately, older people are attending the emergency department, and while I would encourage anybody who is sick to go there, they are spending hours and hours on trolleys. It is like a circus. Trolleys bash off one another, there is no space in the hallways, and staff cannot give appropriate care due to the lack of space, the number of people who are presenting and the failure of the Government over the years to deliver the services we need and the number of beds we need.

The Government’s plan has for a new 96-bed unit that will actually deliver 48 new beds. That is not going to happen for another two years, so we will be left with two more years of this crisis, which is only getting worse. There is no plan to get us out of this. We have been talking about it for seven years and, as I said, every year it is getting worse. Every month there is a new record. Every month last year, with the exception of one month when there was an intervention, which has already been passed, was a record-breaking month for the number of people on trolleys in UHL. It is incredibly difficult for the staff to work there. They are overwhelmed and understaffed and the hospital authorities tell us an additional 200 beds are needed to bring it up to the national average, but the Government has a plan for only 48 beds in the next two years.

Deputy Jack Chambers

I acknowledge the concerns of the local community and the pressures on the staff. Significant resources are being invested in University Hospital Limerick, which has seen an increase in the workforce of more than 160 whole-time equivalents since the end of 2019. Safer staffing levels for ED nursing staff have been reviewed and national approval was received to recruit additional staff nurses. Recruitment for these posts is complete, with 21.5 staff nurses in post since September 2023. The Minister, Deputy Donnelly, recently opened new theatres, wards and clinical areas at Croom Orthopaedic Hospital, including the development of an ambulatory trauma service that facilitates the transfer of trauma patients from UHL for surgery and recovery, improving patient flow and ED congestion.

A key part of the solution is additional beds for Limerick, and 98 new inpatient beds have opened in UHL since the start of 2020. Construction on the new 96-single bed inpatient block commenced in October 2022 and it is anticipated this much-needed additional bed capacity for the mid-west will become operational in mid-2025. Additional works for the second 96-bed inpatient block will, pending planning permission approval, be carried out directly adjacent to the 96-bed block under construction.

Reform of service delivery as outlined in Sláintecare is vital to deal with the increased demand. This includes the expansion of community care and other measures providing people with the care they need outside of ED and improving patient flow and discharge from hospital with more home support packages and nursing home supports. The matter of ED performance is under constant review by the Minister and the Department of Health through ongoing engagement with the HSE. I assure all Members, including the Deputy as a local TD, that the Government and the Minister for Health are committed to improving ED performance in Limerick and the wider mid-west.

Cuireadh an Dáil ar athló ar 11.08 p.m. go dtí 9.10 a.m., Dé Céadaoin, an 24 Eanáir 2024.

The Dáil adjourned at 11.08 p.m. until 9.10 a.m. on Wednesday, 24 January 2024.