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Cabinet Committee Meetings

Dáil Éireann Debate, Tuesday - 18 October 2016

Tuesday, 18 October 2016

Ceisteanna (3, 4, 5)

Gerry Adams

Ceist:

3. Deputy Gerry Adams asked the Taoiseach when the Cabinet committee on health last met. [28719/16]

Amharc ar fhreagra

Gerry Adams

Ceist:

4. Deputy Gerry Adams asked the Taoiseach when the Cabinet committee on health last met. [30553/16]

Amharc ar fhreagra

Richard Boyd Barrett

Ceist:

5. Deputy Richard Boyd Barrett asked the Taoiseach when the Cabinet sub-committee on health last met. [30616/16]

Amharc ar fhreagra

Freagraí ó Béal (29 píosaí cainte)

I propose to take Questions Nos. 3 to 5, inclusive, together.

The Cabinet committee on health last met on 22 September 2016.

I know the Taoiseach is limited in what he can say on these matters. I wonder what consideration has been given to the crisis in health and the ongoing issues in that regard. Approximately €14.7 billion in real terms is being put into health. This clearly cannot sustain the hospitals or the clinics.

I would like to look at the issue of mental health, in particular. It has been the Cinderella of the health services for a long time. Will it suffer again when we are told at the end of the year that the health budget has been spent? What will happen if the EU says the Government cannot bail it out? Will mental health services be targeted again? I know the Taoiseach cannot talk about the detail of what is discussed at the Cabinet committee, but I suggest that this issue be brought to the committee for its consideration.

Last week, I visited the Ladywell mental health centre in Dundalk, which provides services for much of north Louth. The staff are very dedicated, as we would expect, but the conditions in which they are forced to treat patients are absolutely unsuitable. The building is over 70 years old and is inappropriate for staff and patients. Additional members of staff were allocated to the centre some time ago, which was very welcome, but there were no facilities in Ladywell to accommodate them. Instead, they are working out of St. Brigid's Hospital in Ardee. Patients have to travel from as far away as Carlingford for appointments there.

Is the need for strategic investment in the development and enhancement of mental health services the type of issue the Cabinet committee looks at? The Government loudly announced its decision to set up 14 new primary care centres, and the European Investment Bank cleared a loan of €70 million to that end, but none of the centres are in the north-east region. If one omits the Dublin region, including the constituency of the former Minister for Health, there will be no centres at all in the north east. I would like to know why this is the case. Do citizens and mental health staff in the region not have an entitlement to first-class modern mental health services?

I will conclude by mentioning that there are 444 hospital patients on hospital trolleys today. That is a huge number. Despite the significant efforts of the staff at Our Lady of Lourdes Hospital in Drogheda, the hospital has one of the highest numbers of patients on trolleys. This is the responsibility of the Government. How does the Government expect to cope or deal with such problems if it is not budgeting properly in the health sector? The persistent under-resourcing of primary and community care, which results from Government failures, means that more and more people who do not need to end up in hospital are ending up in hospital. Will the Taoiseach give the House a commitment that the need to tackle primary and community health care, and particularly the issue of mental health facilities, will be raised at the next meeting of the Cabinet committee on health?

Of course the Cabinet committee on health can deal with a particular issue. Deputy Martin asked a question earlier on about the allocation of money to the mental health area. I support his specific suggestion that there should be a subhead dealing with how it is proposed to spend this money and the effectiveness of such expenditure. We have had ring-fenced allocations for mental health for some years, but I do not think it has ever been possible to spend the amount that was allocated. When money is in the budget, there is a need to identify and monitor the outcome and the output of the spend. I am answering the Deputy's question by confirming that the issues he raised are relevant to the general work of the Cabinet committee on health. We can talk about these particular areas at our meetings.

An increase of nearly €500 million was announced in the Estimates for 2017. This will bring the total spend to €14.6 billion. The Minister for Health has pointed out that this is the largest allocation ever made to the health area, taking into account that various Departments were associated with health and children over the years. An additional €1 billion is being provided for health spending compared to the budget for 2016. This represents an increase of 7.4%. Investment priorities include the development of the national children's hospital and the national plan for radiation oncology. The new national forensic mental health service facility is being built in Portrane. The Minister of State, Deputy McEntee, is responsible for this project. An additional €3 million is being provided to support drugs and social inclusion measures. Some €5 million is being provided for the establishment of the Healthy Ireland fund. This fund, for which the Minister of State, Deputy Corcoran Kennedy, is responsible, is important for the well-being and outlook of our people. It will lead to enormous savings over a five-year or ten-year period. The €35 million that is being provided for new mental health services in 2017 is in addition to the €35 million that was provided in 2016.

In the absence of the Minister for Health, who is now present, we were talking about a specific subhead to identify the spend and output. That is an issue of which most people would be supportive. This will enable improvements and better outcomes for the mental health services across a number of age groups and specialties and it will assist the continuing development of an integrated approach to youth mental health and suicide reduction initiatives. As Deputy Adams knows, these are particularly tragic and common, unfortunately. This is the reason the money was put in by the Minister for Public Expenditure and Reform following discussions with the Minister for Health and this is why we have a specific Minister of State post to deal with the mental health area.

I hope those responsible get the message out. It is important to talk to young people in colleges and secondary schools and to get the message out that those who have difficulties from time to time should not be afraid to talk, ask or tell people about it. There has never been more help available. Yet people, given the world we live in, have never felt more lonely, isolated or vulnerable. It is a case of facing up to a tragic phenomenon and encouraging all young people to work with those in their age groups and to highlight that if something is wrong, help is available. That is why there is a specific allocation in the health budget for mental health. That is why there is a specifically appointed Minister of State to work with all of the organisations, including voluntary and NGO organisations as well as statutory agencies to deal with this in the best way possible. If only one life is saved as a result, is that not a benefit?

I always try to say to students in secondary schools in particular that if one in four is to be affected by mental health challenges at some stage during their lives, then it is only right and proper that the State should put facilities in place to encourage these young people and let them know and understand that they can use these facilities and opportunities without fear, anxiety or concern. That is what they are there for. Moreover, just as people get physically sick, so too can they have mental challenges. Young people should understand that. There is nothing new in this. However, it should be understood that we want to help them in so many ways and there are so people who can do that. It is a case of not being afraid to say it, tell it or ask for it. In that sense we are keen to continue to work with them at all times.

There are some supplementary questions.

My question is not a supplementary question.

It is a question. Do you want to ask a question?

It is not a supplementary question. It is a question.

It is a question - my apologies.

I am keen for some clarity on the health budget and the allocations. Can the Taoiseach repeat the date the sub-committee last met? Did he say it was 23 September?

What was the date for the meeting of the sub-committee?

It was 22 September.

Excellent, that is clarity, at least, although I doubt if I will get clarity in response to the rest of my question.

Today the Taoiseach repeated something the Minister for Public Expenditure and Reform said on the day of the budget. It was the assertion that this budget includes the biggest health allocation in the history of the State. That was challenged within minutes of the claim being made during the budget by Susan Mitchell, a journalist with the Sunday Business Post. She also stripped out - I heard the Taoiseach make reference to this - the reduction in the budget that would have resulted from taking out the allocation for the Department of Children and Youth Affairs. She pointed out that the total and absolute budget was bigger in 2008 than it was this year. It is important that we have clarity on who is correct and to have clear figures, comparisons and explanations that stand up in respect of what was taken out of the Department of Health. There was considerable messing around with figures last year on the health budget. I put it to the Taoiseach that we need clarity on this. We deserve that and the public deserves clarity on the health budget. We should also have the honest admission - again this has been asserted by many - that the allocation, if it is an increase, is almost certainly not an increase in real terms when we strip out Lansdowne Road arrangements, the inclusion of the €500 million cost over-run from last year as well as the demographic pressures that would have required extra budget resources in any event. The question is about what service delivery is going to be like. In other words, do we now have additional resources that will lead to additional and improved quality of services? The doctors came out today and criticised the €15 million to deal with the crisis in accident and emergency departments. One group called the allocation pathetic and said it would not deal with the crisis at all.

I would like clarity on mental health. I have just heard a reference to €35 million which the Taoiseach said has been allocated. However, in the Budget Statement reference to additional funding for health, there is no reference to mental health whatsoever. Instead, there is reference to the level of mental health services being delivered within the available funding. Is it the same? That is what I want to know. Have we given additional funding to mental health? The commitment of the Government and of the House is to the full implementation of A Vision for Change to deal with the fact that our mental health teams are at 48% of the staffing levels they should have and that we need 24/7 emergency mental health services.

My next question is on home care packages. I have asked this question several times, including during the budget debate and in respect of specific people. There was crowing about the fact that there will be 950 extra home care packages, but this is still 6,000 home care packages south or less than it was before the cuts started in 2008. I want a simple answer from the Minister for Health, who is sitting near the Taoiseach. It relates to the cases that I have on my desk - I suspect others have them as well - involving people whose need for home care packages is acknowledged. Are they going to continue to be told that the budget is not there? That is what I want to know.

Deputy, if you want an answer you will have to give way. I am trying to be helpful. If you want a response, the Taoiseach has 30 seconds.

I have 30 seconds. Is that correct?

You have 30 seconds.

God almighty.

The first thing I will say is that Deputy Boyd Barrett should wait until these questions are finished because the Minister for Health is in the House to answer questions presently. He will provide Deputy Boyd Barrett with the detail of all these things, including a detailed statement on the website of the Department of Health which deals specifically with the question from Deputy Boyd Barrett.

Unfortunately, I do not have speaking time during Priority Questions.

Once all the appropriate adjustments are made on a like-for-like comparison, for 2017 the allocation is €14.607 billion.

It was €15 billion in 2008.

That is €566 million greater than the 2008 allocation, which was the previous highest year. If Deputy Boyd Barrett checks that, he will find out it is the case.

I want to move on because time is expired.

I could give Deputy Boyd Barrett more details if he wishes.

You will have to do it in another way.

What about my question on mental health?

You will have to find another way, Taoiseach.

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