Dáil Éireann díospóireacht -
Wednesday, 24 Apr 2024

Vol. 1052 No. 8

Ceisteanna ó Cheannairí - Leaders' Questions

Deputy Mary Lou McDonald

Tá fáilte romhat, a Edwin. I am not used to seeing you in this setting, but you are very welcome. I am sure we all agree on that.

Over the last few days people have listened in horror to the testimony presented at the inquest into the death of 16-year-old Aoife Johnston. Aoife died in University Hospital Limerick on 17 December 2022. The inquest is ongoing and we await its verdict. We have heard that on that fateful night in 2022 when Aoife presented to the emergency department it was under enormous sustained pressure. The senior house officer on duty that night has said that nursing staff were "overwhelmed" with patients seeking treatment. She said that staff were left in an "impossible situation" due to the severity of the overcrowding. Staff shortages were a huge issue and the doctor said that the emergency department was "not a safe environment" for patients. Aoife had presented with suspected sepsis, so time was of the essence, but she was left waiting for 13 hours, lying across two chairs as a makeshift bed, before eventually being seen by a doctor. There was not even a trolley available for her. Aoife’s heartbroken parents Carol and James called out for help as their daughter deteriorated, but have said that there was no help. Carol said “we watched our daughter die – I wouldn’t wish it on anyone”.

I raise Aoife’s case because it speaks, in the most heartbreaking way, to the depths of the crisis at University Hospital Limerick. The chaos in the emergency department that Aoife and her family faced that night is what faces patients and staff all the time. The hospital’s full overcrowding alert was enacted every other day last year. We should let that sink in for a moment. This is a hospital operating at permanent surge capacity and the surge is every single day. UHL is in a constant state of emergency because it simply does not have the level of staff or beds it needs to deal with demand. The result is chronic overcrowding, persistently high trolley counts and people denied healthcare with thousands of appointments cancelled every month. The hospital is short 200 vital staff. The panels are in place but staff cannot be recruited because of the Government’s embargo. The blocking of recruitment when a hospital is on its knees just beggars belief. To get ahead of this crisis, the hospital also needs 288 additional beds and it needs them to be delivered rapidly. While the Taoiseach’s Government has announced some limited measures, they fall far short of what is required and the reality now is that staff, patients and the public in general feel very unsafe. Is mór an chailliúint í Aoife Johnston. Thug a bás léargas ar na fíorchontúirtí a bhaineann le róphlódú in Ospidéal na hOllscoile, Luimneach. Tá fíorathrú ag teastáil ó mhuintir an mheániarthair maidir le cúram sláinte.

This cannot go on. The people of Limerick and the mid-west are at the end of their tether with the constant crisis in their hospital. They are screaming out for action and they believe the Government is not listening. They want the Government to effectively address the crisis with speed and purpose. Here is what the Taoiseach's Government must do: firstly, it must end its dangerous recruitment embargo so that University Hospital Limerick has the staff it needs to meet demand; secondly, it must deliver the additional beds the hospital needs with urgency to tackle overcrowding; and thirdly and importantly, it must invest ambitiously in local out-of-hours community health services to relieve pressure on the emergency department. These three steps would transform the situation. Will the Taoiseach take them?

The Taoiseach

Gabhaim buíochas leis an Teachta. I thank her for raising this very important issue. I join the Ceann Comhairle and the Deputy in welcoming Speaker Poots to Dáil Éireann. It is great to have you here and everyone in this House looks forward to working with you and colleagues and counterparts in the Northern Ireland Assembly and the Northern Ireland Executive.

I thank Deputy McDonald for raising this extremely important issue. She alluded to the inquest into the death of Aoife Johnston being in progress and I am very conscious of that. Like the Deputy, I do not wish to say anything to cut across that process. We will certainly all have a lot to say when that process concludes. I express my deepest sympathies, and I know the sympathies of everyone in this House, to the family of Aoife Johnston. I cannot imagine their pain, their grief at the loss of a daughter and sister and the pain they are living with every day. The inquest is ongoing so I will refrain from commenting on that, but as the Deputy knows, the chief executive of the HSE, having considered a report he received into the death of Aoife Johnston, which had very significant findings about the care of Aoife and the operation of the hospital, appointed the former Chief Justice, Mr. Justice Frank Clarke, to conduct a formal investigation. The outcome of that investigation is going to be very important – I am sure we can all agree on that – in informing any further decisions that need to be made. In instigating this investigation the HSE CEO quite rightly apologised unreservedly to Aoife’s family and moved to assure them that any issues raised will be investigated thoroughly, fully and without fear or favour. I add my voice to those sentiments. I understand the HSE expects that report from Mr. Justice Clarke by the end of May, but of course it is important that he has sufficient time to fully complete that work and deliver a good and robust report.

I fully accept that there is a very serious situation at University Hospital Limerick. It would be simply not credible to suggest anything to the contrary, but I need to say that against a backdrop of legitimate questions that need to be asked in terms of the level of investment that has been made in that hospital. Let us look at a number of facts. Staffing at the hospital has grown by over 1,100 since the end of December 2019, or from over 2,800 staff at that time to over 3,900 staff as of the end of February. This is a 42% increase in staffing levels in the hospital. It includes very specifically 161 more doctors, 49 more hospital consultants, 433 more nurses and midwives and 116 more health and social care professionals. University Hospital Limerick now has more emergency department consultants than any other emergency department in Ireland.

I want to pick up a valid point the Deputy has raised, which I have heard her make a few times. I have raised it with the HSE as recently as today. The Deputy talks about the safe staffing levels and the nurse numbers required in the hospital. I have been told, very categorically in black and white here, that the extension of safe staffing to EDs and to general and specialised medical and surgical settings is fully funded. Therefore, I absolutely expect the delivery of the safe staffing levels to EDs and to general and specialised medical and surgical settings in UHL and indeed all hospitals. I am going to pursue that on the basis of the issue the Deputy has raised and I will come back to her. I have also seen that the budget for the hospital is now €382 million. That is a 44% increase in five years. There is no other hospital in the country that has seen that level of increase. The recently published hospital activity report, which gives an overview of the change in expenditure at hospital level, places UHL at the top. Total expenditure in Limerick has more than doubled. It is the largest increase in expenditure over the period.

I turn to the three specific issues the Deputy has raised, all of which are sensible. On the embargo, we live in a country with a health budget that sees capacity for 2,200 net additional posts within the health service this year. We can debate around recruitment, but there is funding for 2,200 additional posts. There will be more nurses, more doctors, more therapists and more people working on the front line of healthcare at the end of this year than at the start of it. I have been very clear on safe staffing levels and the fact they are fully funded in the settings I have outlined. I will come back specifically on the Deputy’s view on the impact of recruitment on the staffing levels in that hospital. The second point was on beds and the Deputy acknowledged we have worked to increase bed capacity while saying we need to go much faster and much further. We have already had 150 new beds open in the University of Limerick Hospital Group since January 2020, with 98 of them at the hospital. Work has commenced on a 96-bed ward block at the hospital in Limerick and there have been a number of other interim measures taken in recent weeks that I can perhaps come back to in a moment.

Deputy Mary Lou McDonald

The Taoiseach says he is listening, but clearly he is not. If everything were as rosy as he portrays, how is it that University Hospital Limerick consistently has the highest trolley count? How is it that front-line staff and their unions consistently have said they do not have the staff to deal with the level of demand? This is a hospital that is enduring surge every single day. The Taoiseach is not disputing that fact.

The Taoiseach

No.

Deputy Mary Lou McDonald

The facts as they present on the ground are that the emergency department is not safe.

People do not believe the hospital is safe, and that is a major problem. The panels have been established. Additional staff are needed, as are additional hospital beds.

We have to start from a position of acceptance. The Taoiseach can quote whatever figures he wishes. We could go into the history of the closures at Nenagh and Ennis, which created a regional pressure point at University Hospital Limerick. . That is all in the past, however. We need to deal with the present. In the current circumstances, the situation is unsafe. Rather than trading numbers with me across the floor of the House, I would like a commitment from the Taoiseach that the recruitment embargo will end, that the additional staff will be recruited, that there will be far greater ambition as regards beds and that he will make this hospital safe again. That is the demand from Limerick and the mid-west.

The Taoiseach

I say this respectfully, but it is hard for me to answer the question if, when I use a number or statistic in answering, the Deputy just tells me I am not listening or asks me not to quote statistics at her. When she quotes statistics at me, I reply. When she asks a question, I endeavour to answer. I made the point that context is important. It is important for people in Limerick who are watching this discussion today. The impression is sometimes given that resources are not going into a hospital. This is a hospital that has more emergency department consultants than any other hospital in Ireland. That has to be acknowledged. We must have an honest debate. It is a hospital that has seen a greater increase in staffing levels than many other hospitals and which has had a massive increase in its budget. As the Deputy has acknowledged, we are also taking more measures in respect of beds and bed capacity.

Deputy Mary Lou McDonald

The hospital is unsafe. The Taoiseach should acknowledge that.

The Taoiseach

Hang on a second. Every day, there are many people in that hospital getting very good treatment and there are many incredible people working in it. The Deputy and I have acknowledged that.

Deputy Mary Lou McDonald

That is not in question.

An Ceann Comhairle

We cannot have a conversation on the matter.

The Taoiseach

I am sorry; I am trying to be helpful. There have been a number of very difficult issues. One of these is before an inquest which neither I nor the Deputy wish to cut across at this point, although we will both have plenty to say when it ends, as is appropriate. However, I accept that there is a need to do a great deal more in Limerick. I am telling the Deputy that I am specifically following up on the safe staffing levels for Limerick, which have been funded. The Minister for Health recently outlined a number of additional measures he intends to take in the here and now to increase capacity. It is not a question of a lack of budget or a lack of willingness to do more. There is also a need to ask why we are not seeing improvements for patients when we are putting so much additional investment into a hospital. That is what the Minister intends to get under the bonnet of.

Deputy Holly Cairns

For years now I have been raising the issue of specialist treatment for eating disorders. The news that no new inpatient beds for adults with eating disorders have opened should be surprising but, given all of the broken promises and missed deadlines over the years, how could anyone be surprised? We should be, however. We should be shocked at the lack of urgency, the level of mismanagement and the complete lack of help and hope for so many people who are seriously ill.

In 2018, when the Taoiseach was the Minister for Health, the HSE published a new national model of care for eating disorders. Under that plan, 20 new inpatient beds were promised. They were supposed to be delivered by 2023. To date, zero have been delivered. Not only has there been an abject failure to deliver these beds, but there has not even been an attempt. The Journal has confirmed today that no new funding to open these beds was provided at any stage in the past six years. As it stands, there are just three public beds in the entire country for adults with eating disorders, all of which are located at St. Vincent's hospital. That means that only people who reside within that hospital's catchment area can get treated in those beds. There are three beds for the entire country, and most of the country cannot use them.

I have to say that it does not seem like the Government understands how serious eating disorders are. Over the years, I have spoken to women who have been forced to speak publicly about what they are going through and to set up GoFundMe campaigns to get the care they need. I have spoken to parents who are at their wits' end watching their children quite literally waste away in complete disbelief that there is no support for them. I have spoken to people who work in the NHS who are seeing Irish women who are at death's door and who are going over to the UK because they cannot get the care they need at home. That reality is not represented at all in the Government's response. There has been zero funding to provide more beds at any stage in the past six years.

Anorexia has the highest mortality rate of any mental health condition and incidences are rising. In 2022, admissions were the highest in a decade. Despite this, when people are at death's door, when early intervention is obviously not an option, there is nowhere for them to go because the beds do not exist. The HSE will sometimes pay for private treatment while other times it will not. There is no clarity or transparency as to how decisions in this regard are made. I acknowledge that there has been some progress with regard to care in the community but we know that many people are far past the point of needing that early intervention. It is not an option for some people. They urgently need inpatient care. Twenty new inpatient beds for adults with eating disorders were promised in 2018. When will they be delivered?

The Taoiseach

I thank Deputy Cairns for raising this issue. I acknowledge that it is an issue she quite rightly raises on a regular basis. I assure her that I wish to show commitment to enhancing specialist services for eating disorders, including improved access and shorter waiting lists. I accept that this is an issue in every community across Ireland. I also agree that there has historically been a lack of publicly funded services for people with eating disorders in Ireland. We are starting from a very low base as regards the record of investment. However, I point to the fact that the new model of care for the national clinical programme for eating disorders in 2018, which the Deputy has referenced, marks a significant milestone and provides clarity as to how we intend to deliver and design our services. It also provides a list for Government as regards initiatives that quite rightly need to be funded.

Research shows that the most effective treatment setting for eating disorders is in the community. I will come back to the point the Deputy has made about treatment outside the community in a moment. It is right to say that a small number of people, mainly those with restrictive eating disorders, will require inpatient care for stabilisation and for other reasons. However, 90% of eating disorder services are delivered within the community. The HSE works hard to meet the needs of people with eating disorders in a setting most appropriate to their needs. This might be through the community eating disorder teams, beds in the public system, specialist beds with private providers that are funded by the HSE, which the Deputy acknowledged, or, on occasion, the treatment abroad scheme, although we definitely need to reach a point at which we can move away from that.

Based on multidisciplinary community teams, the national clinical programme for eating disorders is now being implemented on a phased basis across the country. There are now 11 teams, comprising six adult teams and five child and adolescent mental health service teams. Six of these teams only started last year. I say that to push back slightly on the suggestion of a lack of progress. We started six of these teams in the last year. More than €8 million has been allocated to the national clinical programme since its establishment and approximately 100 posts have been funded through that programme. There are now just over 80 eating disorder clinicians in the country. This number includes ten consultant psychiatrists.

Adults who have an eating disorder diagnosis and require inpatient care can be referred to any of the HSE's acute inpatient mental health approved centres around the country. Eating disorders disproportionately affect a relatively young section of our population. There are currently 20 dedicated eating disorder beds across the four CAMHS inpatient units. As of 23 April, there was nobody waiting for access in that area. Access to services is increasing. Twice as many assessments were conducted last year as were conducted the year before. That is 449 assessments versus 227. As part of additional funding secured under the last budget, a number of new posts will now be available to support youth mental health service provision and development. This includes specific new posts to support eating disorders.

On St. Vincent's specifically, community healthcare organisation, CHO, 6 has three dedicated beds for adults requiring inpatient care and these are based in St. Vincent's. The Deputy is entirely correct that the need for additional inpatient beds has been identified in the model of care and in other policy documents. A recent HSE mental health bed capacity review included eating disorder beds. It is intended that the number of dedicated adult beds will increase in line with the model of care recommendation to get us to 20 adult inpatient beds.

Deputy Holly Cairns

As I have said, I welcome the opening of the 11 treatment hubs. Care in the community and early intervention are obviously of great importance. I acknowledge that. It is not what I asked the Taoiseach about-----

The Taoiseach

It is linked.

Deputy Holly Cairns

-----but we are missing the target in that area too. Some 16 treatment hubs should have been opened by 2023. Treatment remains a postcode lottery. It is not just adult services that are at breaking point but also those for adolescents. In some areas, 45% of beds are empty. According to the Psychiatric Nurses Association, the HSE's recruitment embargo is the reason for that. There are simply not enough staff for them. Is it the Government's plan to lift that embargo to address this issue?

To go back to what I actually asked the Taoiseach about, more desperate than that situation is the issue with inpatient beds for adults.

The Taoiseach acknowledged that we need them, but no funding has been allocated. Will he tell us when funding will be allocated and when we will see the delivery of those 20 inpatient beds for eating disorders?

The Taoiseach

I fully acknowledge the need to get from three to 20 beds. That is a statement of fact. It is Government policy. It is in the model of care and other policy documents published by the Government and has been endorsed by the HSE mental health bed capacity review. I outlined that this year the area of priority for additional investment into this area is around some of the youth mental health and CAMHS provision. I can send the Deputy a note on what we intend to get done this year. It was interlinked to make the point that at CAMHS level we have 20 beds across the four areas and as a result we had-----

Deputy Holly Cairns

They are not staffed.

The Taoiseach

As a result, zero people were waiting for beds yesterday. I needed to say that. The direct answer to the Deputy's question is that we need to get from three to 20 beds. I intend to make more progress on that in the budget.

On recruitment, all of this has to be seen in context. Sometimes, the debate in the House is a little skewed. There is not a ban on recruitment to the health service. Some 2,200 more people net will work in the health service - it will probably be more but 2,200 have been funded - at the end of this year than last year. That is true. That does not include disability services. The figure goes up to more than 3,000, if disability services are included. Within the budget relating to this area, the HSE needs to make decisions as to where to direct that investment on the front line. I will specifically talk to the Minister for Health about the importance of this area.

Deputy Mick Barry

Access to safe, clean water and sanitation is a human right. It is a right that has been compromised for thousands of Cork city households. For the best part of two years now, brown and orange, dirty, discoloured water has poured from those taps. Eight days ago, the Tánaiste asked Uisce Éireann for a clear timeline for solving this problem. The public has heard from Uisce Éireann on a number of occasions in the past week, but there is still no timeline. It is increasingly clear that the ancient water pipes that lie beneath the ground in Cork city need to be replaced as a matter of some urgency. Uisce Éireann tells us that 54% of the pipes are cast iron and are between 65 and 100 years old. It has quoted a cost of €500 million for those pipes to be replaced. Will the Taoiseach commit to spending this money if it is the only way to fix the problem? What will happen in the meantime?

Households are spending €15 a week and more on bottled water. That is €750 a year, which is the price of two or three water charges. These households should not be forced to pay one single cent. I ask the Taoiseach to ensure they do not do so. Will he commit to coming up with a scheme to provide safe, clean water to the people in affected areas free of charge? That could involve organising tankers full of water to tour communities and stop off at distribution points; providing households with vouchers that could be exchanged in shops for bottled water; or providing households with supplies of filters to be fitted to taps. One way or the other, households have to be relieved of this financial burden in a cost-of-living crisis and safe, clean water needs to be supplied by this State.

Last Thursday night, nearly 100 people gathered outside the Church of the Ascension at Gurranabraher and marched down Cathedral Road in protest. I do not think that will be the last protest of its kind. A campaign is now under way and it can grow. The Taoiseach needs to familiarise himself with the issues here. This is a big issue in the second largest city in the State. It is not going away. The Taoiseach needs to be able to answer the question about a timetable for getting it sorted and providing the funds to do so. He also needs to be able to answer the question about emergency reliefs for households now forced to shell out large sums of money for bottled water. I look forward to his reply.

The Taoiseach

I very much welcome the Deputy's commitment to investment in our water services. I thank him for raising this important issue in the Dáil, as he did last week. Uisce Éireann is working to address the issue of water supplies in Cork city, which I accept is a real issue. There are approximately 600 km of water mains in Cork city. About 50% to 60% of them are made from cast iron and are approximately 100 years old, dating back to the 1920s. Due to the age and deteriorating condition of the pipes, they are prone to burst, which gives rise to leaks. In the old cast iron mains, sediment can become dislodged during repair or upgrade works. That can occasionally be carried through to customers' taps, leading to water that can, very unpleasantly, appear brown or orange when someone turns on a tap.

Uisce Éireann has established a water quality task force, which is dedicated to improving the city's water quality. That task force is now implementing a plan that includes increased sampling at customer taps, at the network and at the treatment plant, intensified flushing programmes and a water mains replacement programme. Uisce Éireann continues to advise people not to drink discoloured water and to run the tap to restore water to a clear colour. The water is safe to drink once it runs clear.

Protecting public health is of course a top priority for Uisce Éireann and the Government, as I am sure it is for everybody in the House. The treatment process used by Uisce Éireann at the Lee Road water treatment plant is fully in line with national and global water treatment standards. Uisce Éireann continues to review the operational performance of the Lee Road water treatment plant. It is also investigating additional options to further improve water services in Cork city.

More broadly, we remain absolutely committed to providing investment in water infrastructure. No one can say that my party ever hid from this issue. Uisce Éireann has invested more than €100 million to improve water supply infrastructure across a number of projects, including the Cork city water supply scheme, which is nearing completion, the replacement of the Churchfield reservoir roof, the upgrade of the Glashaboy water treatment plant, and a new water treatment plant on the Lee Road. These are very significant investments that have been made in the water supply at Cork. I accept there is more to do.

There is a commitment in the programme for Government to ensure that Uisce Éireann is sufficiently funded to make the necessary investment in drinking water and wastewater infrastructure. I have written to the Deputy today regarding this matter. I am engaging with the Minister for housing and Uisce Éireann on the timelines and clarity for people in Cork, for whom this is an important issue.

Deputy Mick Barry

The Taoiseach mentioned Uisce Éireann's new task force, which came about under pressure from below. It is there now, however. It seems to operate in quite a closed and secretive way. I have asked, as have campaigners, that a representative from one of the affected communities be appointed to the task force. We asked that an experienced water worker representative also be appointed to that task force. There has been no joy from Uisce Éireann in that regard. Perhaps the Taoiseach will voice his support for those basic democratic demands in the Dáil today. He spoke about the flushing plan Uisce Éireann is putting in place that was announced last night, which is to target areas on the north side of the city, including Gurranabraher and Montenotte. It is no accident that Gurranabraher is one of the communities, given the protest there last week. Again, that was due to pressure from below.

The feedback we have from water workers and people living in communities where flushing programmes have taken place is that while they have an effect in the short term, the problem tends to re-emerge after a period, sometimes to the point of being as bad or even worse than it was previously. Will the Taoiseach please give me a reply to my question on emergency reliefs in his summing up?

The Taoiseach

The phrase "under pressure from below" is not one I am particularly familiar with. I certainly believe the way to get things done is through engagement. That might be a difference in political ideology. It is important to engage on these matters. The Deputy is a directly elected Member of this House. He is doing his job in engaging on behalf of his constituents. He corresponded with me on this and I have signed a letter to him today on it. He has raised the issue in the Dáil and I am engaging with Uisce Éireann on it.

I very much welcome the fact that Uisce Éireann has established a task force. It is an indication of the seriousness with which Irish Water is rightly taking the issues being experienced by some of the Deputy's constituents and people in Cork regarding water quality. It also very much highlights an issue we have been trying to highlight for a very long time, namely the need for decent investment plans for water and water quality in this country. We have had those debates in the House previously. I will come back to the Deputy on the emergency works as I need to get an update from Uisce Éireann in order to provide him with factual information on that matter.

Let there be no doubt that the Government is very committed to addressing these issues, to continuing to invest in the water supply and water treatment and to supporting the work of Uisce Éireann. We will not be found wanting in assisting Uisce Éireann as the task force carries out its work. There are practical things it is doing, some of which I outlined, that I hope will reassure the Deputy's constituents that this a matter is being taken extraordinarily seriously.

Deputy Marian Harkin

Under the current national planning framework, the Government has committed to achieving a 50-50 split in population growth between the eastern and midlands region and the other two regions, namely the northern and western region and the southern region. However, based on the latest population statistics from the CSO, 55% of population growth has taken place in the eastern and midlands region. Much of that growth has been overly concentrated in the greater Dublin area. Consequently, population growth has been much lower in the northern and western region. These population trends are leading to increasingly greater regional imbalances.

So many of my contributions to Leaders' Questions over the past four years have focused on the growing regional imbalances during the lifetime of successive Governments. I have quoted pretty shocking disparities in GDP, household income and healthcare, but today I will concentrate on two issues further contributing to a widening of those regional gaps. I refer to housing completions and the gap in infrastructural spending. Failures in many sectors I have mentioned before and the ones I am mentioning today contribute to the fact the Government is failing to meet its commitment to a 50-50 split in population growth between the regions.

In regard to spending on major infrastructural projects, the EU Commission regional competitiveness index ranks the northern and western region's infrastructure at 218th out of 243 regions. We are in the bottom 10% of all EU regions. Why is this the case? A few months ago, Dr. Ray Griffin, speaking at the relevant committee, said he had done significant work on capital trackers, that is, tracking major capital spending. As the Taoiseach knows, it is difficult to do that in real time. However, Dr. Griffin's first-generation analysis shows 64% of capital spending on major projects goes to Dublin. On a second iteration, he revised that to 56%, but it is still a 2:1 ratio. That answers the question as to why.

In regard to regional housing activity, the picture is awful. In January, the CSO released the 2023 data on new dwelling completions in Ireland. Some 11% of those were in the northern and western region, yet we have 17% of the population. A further 24% were in the southern region, which has 33% of the population. Some 65% were in the eastern and midlands region, which has 40% of the population. Under this Government and those that preceded it, regional imbalances are escalating across one sector after another. What does the Taoiseach propose to do to change that direction of travel?

The Taoiseach

I thank the Deputy for raising this question. Before I had this role, I used to take Leaders' Questions on an interim basis. On foot of that, I know that this is an issue the Deputy raises on a regular basis. I accept her sincerity and bona fides in respect of this matter.

I will begin by pointing to some areas we have made progress on. When we talk about population and where we want people to live, we must recognise that people have a say in this too. We have to make it easy for people to want to live, study and work in the regions. We can set targets nationally and use funding but ultimately we have to win hearts and minds and make sure young people living in Sligo believe young people can continue to live, raise a family, have a job and access a university in Sligo. We also want people from other parts of the country to want to live in Sligo. We have taken a number of steps in recent times. The Deputy and I worked together on the Atlantic Technological University. She was a big supporter of that project. The university has made a real difference because people can now pursue their PhDs in Sligo. There is now a big university in the north west that can interlock with Ulster University's Magee campus in Derry. That will be a game-changer. I accept that there is work to do, and we will talk more about the technological university. However, the technological university is an example of our commitment to regional development. Not only does such development help keep young people in the regions longer, it also helps to attract investment. When the Deputy or I talk to any company looking to invest in a certain part of Ireland, access to a university in a region is a big consideration. The north west did not have one, but it now does. That happened under this Government, which is worth stating.

On a community level, the Deputy would nearly blush if she looked at what Sligo got for community centres compared with my constituency. In Sligo, Government funding for two new community centres were announced this week, one in Ballymote and one in Kilglass. That is direct investment by the Government, as Deputy Feighan reminds me, in Sligo. That is important.

In the context of the local improvement scheme and roads, we have seen more investment. In that context, €1.1 million was announced for Sligo County Council in the past week. Those are practical examples.

I take the Deputy's point and I do not disagree when she says that we need to do more when it comes to balanced regional development because it is good for all of the country. It is also good for Dublin to have balanced regional development. We have had an over-concentration of growth in certain parts of the country.

When we look at jobs, there are encouraging signs. We have seen 90,000 jobs created in the past year, about 1,700 per week. Around 10,000 of those jobs were in the Border region, including Sligo.

How do we take this forward? We take it forward through the first revision of the national planning framework. I will work with colleagues in the House, including those across the floor, in respect of that. We will publish a draft of that revision this summer, and there will be an opportunity for the Deputy and others to make a submission on practical measures to help get to the 50-50 split we wish to see. The population has grown much more quickly than anticipated and it is now clear we will have to target significant growth in the regions. I suggest that the 55-45 split has probably been somewhat distorted by the significant and unexpected population growth since the national planning framework was last published.

Deputy Marian Harkin

I thank the Taoiseach. He spoke of people wanting to work, study and live in the regions and of winning hearts and minds. What he needs to do is build houses. Stop talking about hearts and minds or community centres here and there, although the latter are welcome and great to see. I am talking about the big-ticket items, and the Taoiseach knows that. I am talking about systemic investment in the regions and investment in big projects like roads and health infrastructure.

Time and time again, different Ministers and taoisigh tell me about the bits and pieces that come to the region. Of course they do. They go to all regions, but that is not what I am talking about. The Taoiseach knows I am talking about major investments. I told him the EU Commission - not me - ranks the northern and western region in the bottom 10% of all EU regions for major infrastructure. The Taoiseach cannot get away with telling me he is giving a bit of money here and there. The Government needs to systematically look at this, change direction and ensure that it builds the houses that are not being built.

The Taoiseach

I am a little disappointed with that response. Hearts and minds matter because we live in a democracy. The Deputy can wave her hands at me if she wishes, but I am going to speak for a second and am not going be told to stop talking about certain things. I am going to continue to talk about the fact that this Government has proudly invested in Sligo. From time to time, it might suit others to suggest the contrary. I have been up and down the road to Sligo so many times for so many Government announcements. The Minister, Deputy Humphreys, was there at the weekend. I am sure if the Deputy was at the events she was not describing them as bits and bobs or bits and pieces. These are important initiatives that matter to people in Sligo. I will come back to Sligo and talk to the young people about what they want to have in their communities.

Deputy Marian Harkin

Build houses.

The Taoiseach

They want houses. Let us talk about housing. The document I have in my possession was issued this morning. It has not been brought up in the Dáil yet, and I wonder why. It indicates that commencements of new houses in quarter 1 of this year are up 63% on quarter 1 of last year.

Deputy Marian Harkin

They are not in Sligo.

The Taoiseach

The provision of housing is rising in all parts of our country. Government investment in housing is rising in all parts of our country. Decisions we took in Cabinet yesterday to spend more than €300 million of taxpayers' money will help small developers and the local authority in Sligo to build more homes. The investment in the first homes scheme will benefit young people in Sligo. The development waiver will benefit young people in Sligo.

The technological university will benefit more people in Sligo. The 10,000 jobs in the Border region will benefit more people Sligo. The community centres that we announced this week will benefit more people in Sligo. Yes we have more to do on balanced regional development but the Deputy does not need to convince this Government of the importance of investing in the regions.