Neasa Hourigan
Ceist:5. Deputy Neasa Hourigan asked the Taoiseach when the Cabinet committee that deals with drugs policy will next meet. [30915/23]
Amharc ar fhreagraTuesday, 4 July 2023
Ceisteanna (5, 6, 7, 8, 9, 10, 11, 12, 13)
Bernard Durkan
Ceist:6. Deputy Bernard J. Durkan asked the Taoiseach when the Cabinet committee on health will meet next. [30964/23]
Amharc ar fhreagra
Mick Barry
Ceist:7. Deputy Mick Barry asked the Taoiseach when the Cabinet committee on health will meet next. [32130/23]
Amharc ar fhreagra
Aindrias Moynihan
Ceist:8. Deputy Aindrias Moynihan asked the Taoiseach when the Cabinet committee on health will meet next. [32450/23]
Amharc ar fhreagra
Pádraig O'Sullivan
Ceist:9. Deputy Pádraig O'Sullivan asked the Taoiseach when the Cabinet committee on health will meet next. [32451/23]
Amharc ar fhreagra
Richard Boyd Barrett
Ceist:10. Deputy Richard Boyd Barrett asked the Taoiseach when the Cabinet Committee on health will next meet. [32540/23]
Amharc ar fhreagra
Bríd Smith
Ceist:11. Deputy Bríd Smith asked the Taoiseach when the Cabinet committee that deals with health will next meet. [32547/23]
Amharc ar fhreagra
Gino Kenny
Ceist:12. Deputy Gino Kenny asked the Taoiseach when the Cabinet committee on drugs policy will next meet. [32556/23]
Amharc ar fhreagraRichard Boyd Barrett
Ceist:13. Deputy Richard Boyd Barrett asked the Taoiseach when the Cabinet committee that deals with disability will next meet [32550/23]
Amharc ar fhreagraFreagraí ó Béal (16 píosaí cainte)
I propose to take Questions Nos. 5 to 13 together. The Cabinet committee on health last met on 19 June and is currently scheduled to meet next on 24 July. The Cabinet committee on health oversees the programme for Government commitments relating to health and receives detailed reports on identified policy areas. It considers the progress of health reforms including Sláintecare, the reform of disability services and the development of mental health services. The Cabinet committee also maintains an overview of public health, including the impact of Covid-19.
Drugs policy is multifaceted and involves work carried out by multiple Government Departments. The focus of a particular drug policy would inform which Cabinet committee considers it. In addition to the meetings of the full Cabinet and Cabinet committees, I meet with Ministers on an individual basis to focus on different issues. I meet regularly with the Minister for Health to discuss progress and challenges in the area of health, including the Sláintecare reform programme.
Sláintecare is happening with the support and oversight of the Department of the Taoiseach through the Cabinet committee on health, which I chair. It is about four main things: making healthcare more affordable, making it more accessible for our people, ensuring better outcomes for patients and reforming the way our health services operate. We are committed to expanding the core capacity of our acute hospitals with more health professionals and more acute hospital beds. Over the past three years, we have added nearly 1,000 hospital beds and 360 community beds, with further additional beds being planned for this year and next year. We have increased the total public health sector workforce by more than 20,000 since this Government was formed. That includes 6,500 extra nurses and midwives. We now have among the highest number of nurses and midwives per bed and per head in the world. There are 3,200 social care professionals and 2,000 doctors and dentists, bringing us to or slightly ahead of the OECD average.
There is a strong pipeline of capital projects, including several new hospitals and significant new facilities for existing hospitals. Just over €440 million is being provided to reduce waiting lists in 2023. Our multi-annual approach resulted in an overall reduction in the number of patients waiting more than ten to 12 weeks by 11% in 2022, with a target of a further reduction of approximately 10% for 2023. The funding includes €123 million on a recurrent basis for the HSE to introduce modernised care pathways and €80 million has been allocated to various primary care and community care initiatives.
The enhanced community care programme continues to improve healthcare at a more local level. This programme, which is investing €240 million in community health services, is easing pressure on hospitals and in more acute settings. The majority of community healthcare networks, community intervention teams and community support teams are now in place and are providing care closer to home. In the first full year post-implementation, it is projected that the community healthcare networks and community specialist teams will enable between 16,000 and 21,000 patients to avoid attendance at an emergency department.
Work is also ongoing on the reconfiguration of the HSE organisational structures into six new health regions and the establishment of elective care centres in Dublin, Cork and Galway, as well as surgical hubs in Dublin, Cork, Galway, Limerick and Waterford in the interim. We are also making healthcare more affordable at a time when the cost of living is affecting everyone. We have abolished inpatient hospital charges. We are widening eligibility for the GP card, which will allow hundreds of thousands more people to attend their GP without incurring fees. Deputies will be aware of the announcement that was made today that it will be extended to an extra 500,000 people by Christmas. The drug payment scheme threshold also was further reduced so that no individual or household will have to pay more than €80 a month for prescribed medicines.
There are eight contributors and they may speak for up to one minute each.
A constituent of mine recently received correspondence from Cork University Hospital informing him that he had been placed on a waiting list for cataract surgery. He rang the eye department at the hospital to ask what date he had been given for this surgery. The lady on the other end of the line gave him the date. She said it will be in July 2031. My constituent is 82 years of age. He said that that might be a bit of a problem. He said he would probably be in the departure lounge at that stage. The woman then asked him if he was planning on going on a holiday. My constituent laughed, a little bitterly, ended the telephone call and rang yours truly. We are here today to discuss that situation but, more broadly, as of April, there were 40,000 people on waiting lists for eye surgery in the State. What action does the Taoiseach intend to take to remedy this situation?
Does the Cabinet subcommittee on health have a focus on recruitment? It is a very significant issue that impacts community services right across the country. In my area of CHO 4, which is the area of Cork and Kerry, up to 20% of posts for home care assistants were left vacant. These are people who deliver services to people in their homes. This keeps them out of the hospital and allows them to more independently in their communities. It also gives backup to their carer. The Cope Foundation in Macroom, for example, was to have a seven-day service well over a year ago, but it struggled to recruit people. It has taken them until now to make headway on that. Similarly, we have looked abroad to make visas available to people to come into the EU and the country to work. Six months on, of those 1,000 visa applications, no more than 100 have been approved. There needs to be an urgency on recruiting people.
I was here two or three weeks ago and I asked the Taoiseach about an alleged underspend under the Primary Care Reimbursement Service, PCRS, for new drugs. We budgeted €30 million to be spent by the Minister in 2022, but I am being told that only €9.4 million of that has actually been drawn down. As a follow-up to that, I am still awaiting the Taoiseach's response. Yet, there seems to be a lot of secrecy around the national clinical programme, NCP, and the level of detail they are willing to give to me via a parliamentary question. I cannot find out if they are subject to audit, how often their performance is reviewed or how successful they are at doing their job. I am finding it very difficult to get straight answers to very simple questions, such as, for example, how many times the chief clinical officer has briefed the Minister for Health. That is another question to which I cannot get a direct response.
Can I get clarification on the money that was or was not drawn down? In the interests of transparency and so on, I just want to see if we are spending and allotting that money as budgeted for. If we are not doing so, can we not get the NCP to answer some basic questions?
With the publication of the summer economic statement today, the debate on what will happen in the budget is going to crank up. I want the Taoiseach to think about the fact that the cost of disability report suggests that people with disabilities have additional costs of €7,000 to €9,000 per year, but the disability allowance is €220 per week. In other words, the vast majority of people with disabilities in this country not only do not get the sort of support they need to deal with the additional costs of disability, but are left in poverty for life. To make matters worse, it is means tested and as a consequence some people are denied even that allowance, which to my mind flies directly in the face of the UN Convention on the Rights of People with Disabilities. Can we expect in the budget that the Government will raise disability allowance, at least to the level that would take people on the disability allowance out of poverty and acknowledge the additional costs that people with disability have?
I want to raise again the question of Covid payments for front-line workers. We recently saw a protest by hospital cleaners, who were contract cleaners and who are being refused the €1,000 Covid payment, despite the fact that they work daily on the front line. Today it has come to my attention that section 39 workers who are personal care workers for people with disabilities have been refused the payment, and refused on appeal. I understand that this was a decision made by the Government because the workers do not fall into the criteria of any particular framework.
If you were not in this House and you were just out there doing your work and keeping your head down, you would think the Government did a great thing by giving all front-line workers a €1,000 general payment but there are cohorts being excluded even though they worked day in, day out on the front line. The particular cohort I want to ask the Taoiseach about, who have just been told about the loss of their appeal, are section 39 workers looking after people with severe disabilities day in, day out. They have been refused a mere €1,000 for working during Covid. The Government boasts about having a €6 billion surplus so how does it square that circle?
The Citizens' Assembly on Drugs Use is examining the issue of drug use and this is an important issue and assembly. Early indications are that the citizens in that assembly are moving towards a more progressive approach on drug use. That is welcome and it is a reflection of society but the big question is as follows: whatever the recommendations are, will this Government give a commitment to legislate on those recommendations during its lifetime? Without the law being changed, we will be back at square one, the way we are at the moment.
The programme for Government refers to the drug and alcohol task forces. It says that they "play a key role" in implementing the drug strategy; that the Government will continue to support them "in identifying local need in communities"; that it will "support targeted initiatives"; and that it will address "drug and alcohol misuse". The truth is there has been limited progress on this commitment to support those who are on the front line in dealing with the problems of drug abuse and addiction. The funding is dire. For example, the funding for the Tallaght Drug & Alcohol Task Force, of which I am a member, is still below what it was in 2010, despite the fact that the population has exploded, as have drug problems. One issue is that the Minister needs to engage with the task forces. We have a new Minister of State responsible for the drug strategy, Deputy Naughton. The Tallaght Drug & Alcohol Task Force wrote to the Minister of State seeking a meeting and was informed that the Minister of State was not available, with no alternative time being offered. At the very least, should she not be meeting the task forces?
I want to raise the issue of emergency call answering service, ECAS, operators in Navan. Emergency call answering services are critical services. This is a front-line health service. These operators deal professionally with people who are often in the worst crises of their lives. It is a stressful job of great importance. The ECAS workers in Meath have been involved in a longstanding dispute with the company that has the State contracts, namely British Telecom. Workers have made serious allegations of historic bullying and intimidation of 999 operators and the workers have been treated disgracefully. At the heart of the problem is the fact that the Government is awarding contracts to companies that refuse to recognise trade union membership. Will the Taoiseach direct the Minister for Enterprise, Trade and Employment to convince British Telecom of its responsibilities to engage with trade union representatives? Will the Government ensure that workers have a right to trade union membership and that this is always recognised in State contracts?
I would like to bring up the case of the Family Addiction Support Network in Dundalk. The Guerin report and the Drogheda implementation report spoke about the important work it does, particularly with families. It is sometimes the go-to body for those who are not necessarily comfortable with going to the Garda about drug debt, intimidation and the huge issues there are with those matters. Those involved have had numerous meetings with the HSE on funding, but it is not really cutting the mustard. They have even met an organisation that was provided funding and that asked it whether it could deal with some of its overflow. The Garda has carried out fundraising for this organisation because it sees it as necessary. The Minister for Justice has had many interactions with me before on this but we need to see some sort of sustainable funding for an organisation doing necessary work.
I will have to beg indulgence and forgiveness from colleagues as I was not able to take everything down as quickly as I was asked questions. My officials are keeping an eye on this and will come back to Deputies with written replies where I am unable to give a verbal reply.
In response to Deputy Barry's initial question, I am genuinely sorry to hear about his constituent's experience. The policy we have set out in Sláintecare is that nobody should have to wait more than ten to 12 weeks to see a specialist if they need to see one, or more than ten to 12 weeks to have an operation if they need it. We are unlike the vast majority of countries in the world in that we are getting closer to achieving that rather than moving further away. Waiting times in Ireland are considerably lower than they are in Britain, for example, or in Northern Ireland or many other places. However, we are a long way off where we need to be, with about 400,000 people still waiting more than ten to 12 weeks. I do not know about the individual circumstances of the case the Deputy raised but it is possible that the letter was an error. To get an appointment in eight years time would not be typical or anything near the normal waiting time for cataract treatment.
On what we are doing, we are expanding the additional public services, including in Cork. The Deputy will be familiar with the developments that are happening there with the new theatre. The National Treatment Purchase Fund is also an option. We regularly pay for people to go privately and have their operations done. Going cross-border is another option; people can travel to another EU country and the Government will reimburse them fully, not for their travel costs but for the cost of their consultations and operation. There is also an arrangement with Northern Ireland so there are many different options. We understand that people would like to have their operations done as close to home as possible.
Deputy Aindrias Moynihan mentioned the issue of recruitment, which is an enormous challenge and is discussed regularly at meetings of the Cabinet committee on health. There is a huge degree of turnover of staff in the health service. It is also an international labour market, with people coming and going from all parts of the world all of the time. However, we are succeeding, with 20,000 more people working in our health service than was the case three years ago, including 6,500 extra nurses and midwives. We have among the highest number of nurses and midwives per capita in the world. We have recruited 2,000 additional doctors and dentists, and hundreds more consultants, so we are going in the right direction. That is not in any way to deny the gaps that exist in many services and all over the country. It is a real challenge but one in which we are showing some results. We are seeing with the new consultant contract that there is increased interest from overseas. People are not just coming home but fully trained doctors from other countries are also seeing how attractive the consultant contract is in Ireland under the new Sláintecare contract.
Deputy Pádraig O'Sullivan raised the issue of the possible underspend on new drugs. I followed up on that at the time and I did not get a reply either. I thank the Deputy for reminding me and I will check up on it. I would be surprised if it is the case but if it is, I want to know.
We are always being told that we do not allocate enough for new medicines, so an underspend would be quite a surprise.
Deputy Boyd Barrett mentioned the cost of disability report. I am familiar with the report. I think it may have been commissioned by the Government, perhaps by the Minister, Deputy Humphreys. Of course there is a cost associated with disability, but it very much depends on the individual and the disability that they have, and therefore it is very hard to calculate. It could range from a small figure to a very high figure, depending on the person's individual circumstances. The disability allowance will be increased in the budget, but I cannot say at this stage by how much it will be increased. Of course, there are other things that we can do as well around service provision. There was a one-off payment last year as well.
On the payment of the Covid bonus to staff, we have always said that the Covid bonus was not for everyone. For example, gardaí did not get it. It was not for all front-line workers. The basic principle was that first, you should be a Government employee, and second, you should have been exposed to Covid patients on a daily basis. Essentially, that would involve people wearing gowns and gloves who were exposed to Covid patients on a daily basis before the vaccine was developed.
That is exactly what they were exposed to.
I do not know exactly what the individual circumstances are that the Deputy mentioned, but if she wants to send me the details I will certainly make further inquiries about them.
Deputy Gino Kenny raised the Citizens' Assembly on Drugs Use. When it makes its recommendations, they will be considered in good faith by the Government. As with the review that Deputy Bríd Smith mentioned, there is no obligation on the Government or the Oireachtas to accept every recommendation that is made. That would not be right. What we will do is to take seriously any recommendations that are made, consider them properly and in good faith, and then issue a reasoned response. There should not be any assumption or obligation on any democratically elected parliament or government to accept every recommendation that a body makes. That would not be right and would not make sense, in my view.
I will ask the Minister of State, Deputy Naughton, to come back to Deputy Paul Murphy directly on the Tallaght Drug & Alcohol Task Force.
Deputy Tóibín raised issues relating to our laws on trade unions. We are updating our laws on collective bargaining in line with European law. Our existing laws give people the right to join a trade union and protect them from victimisation, but they do not force employers to recognise trade unions. As one very senior former trade union official said to me, even if we could force employers to meet trade unions, we could not force them to come to an agreement. No government could impose an agreement on unions or on employers, unless it was done through the Labour Court system. That is a totally different system. That is a quasi-judicial system. It is not about negotiation. It is about hearing both sides of the argument and a recommendation being handed down. Government contracts reflect our laws, but we are in the process of updating our legislation around collective bargaining. Again, that basic principle needs to be widely understood. You could pass a law forcing employers to meet with unions, but could you ever pass a law that would force people to talk, negotiate or agree?
Let us take the first step first.
Indeed, the union side is very much against the idea of being forced to agree to something, because it wants to be able to have a ballot, etc. The same would apply to shareholders and a board. I did not quite catch Deputy Ó Murchú's question, but I will come back to him by correspondence.