Dáil Éireann debate -
Thursday, 25 Jan 2024

In ár n-ospidéil ar fud an Stáit, bíonn othair a bhfuil cúram práinneach nó éigeandála de dhíth orthu fágtha agus ag fanacht ar feadh uaireanta fada gan leapa agus ar thralaithe. Chuala muid inné faoi fear 87 bliana d’aois a chaith 100 uair in ionad éigeandála in Ospidéal Ollscoile Luimnigh. Tá sé seo scannalach. Tá an Rialtas ag teipeadh ar othair agus ar ár bhfoirne atá ag obair sna hospidéil.

This morning, Professor Conor Deasy, president of the Irish Association of Emergency Medicine, commented on the ongoing scandal in emergency departments. What he had to say should be sending shockwaves through Government Buildings. He described what he called a “dreadful” situation for patients who are waiting for care. He raised the difficulties that staff are facing to provide the care that patients are entitled to. Professor Deasy said: “These patients deserve to be in a hospital bed, a ward bed, and they are being accommodated on the corridors of the wards”. Of course, he is right. Describing the situation at Cork University Hospital, he said that people seem to have become immune to the level of overcrowding in the hospitals and that it is costing lives. He is telling the Government that it is costing lives. Cork University Hospital, which the Tánaiste knows well, is operating at 300% capacity this morning, which is scandalous. Patients in need of urgent and emergency care are languishing for hours on end. Some are putting off even going to the hospital at all.

We heard earlier this week of the case of an 87-year-old man in Limerick. He was left waiting for 100 hours in the emergency department. The Tánaiste and the Government do not seem to care that this is happening on their watch, and it is getting worse. The reliance on trolleys has continued every single year since the Tánaiste was Minister for Health and it has got worse year by year. The INMO yesterday said that overcrowding is leading to very dangerous situations. The situation persists and worsens in hospitals across the State. Dr. Laura Durcan is a consultant rheumatologist at Beaumont Hospital and also the former vice president of the Irish Hospital Consultants Association. She described how admitted patients are in every corner of the hospital. In her words, there is no corner of the hospital that is not at the moment housing an acutely unwell patient who has been admitted from the emergency department.

The facts and the reality are that the Government has abandoned patients and workers to this emergency department chaos. They are in a dangerous system because of the Government and the Minister for Health’s policies. The crisis has been caused by their decisions. I have no confidence in the Government's ability to tackle the trolley crisis. It has missed its waiting list targets and trolley targets and it has stopped the health service from receiving the funding it requires to recruit the front-line staff it needs. It is stumbling from one disaster to another. The consequences are the 87-year-old gentleman in Limerick and the hundreds of others who are languishing on trolleys and chairs in emergency departments.

The fact is we need 1,000 more hospital beds right now. We need 1,500 more beds by the end of next year and at least 2,500 additional beds by 2030, according to the ESRI. We need a strategic workforce plan to train, recruit and retain health workers. To tackle overcrowding, we need a multi-annual plan. Does the Government have one? Of course, it does not. We have heard many announcements of plans for new beds but the Government decided not to fund them in the recent budget. Indeed, it went further and underfunded health this year because it has thrown in the towel. I want to ask this question because the Government is simply incapable of getting the basics right. Will the Government reverse the disastrous decision not to fund the additional beds that are required and immediately approve the funding for those beds that our hospitals desperately need?

Ní aontaím leis an Teachta. Admhaím ar dtús go bhfuil na hospidéil agus na hionaid éigeandála faoi bhrú faoi láthair ach tá plean ann. Ní plean gearrthéarmach atá ann anois, ach plean don bhliain ar fad. Tá infheistíocht faoi leith curtha isteach in ospidéil na tíre seo ó tháinig an Rialtas seo ar an bhfód. Ní raibh a leithéid d’infheistíocht ann le blianta fada. Is í sin fírinne an scéil.

The investment in health has been unprecedented in theplast four years, with €7.1 billion extra since 2019. The Deputy should not be saying that no one cares or that people have thrown in the towel. That is not correct. We need a reasoned, balanced and rational debate, not just shouting and roaring, getting angry and accusing people of bad faith. There has been a 51% increase in about three years. It is an extraordinary investment. Yes, there have been very significant pressures on emergency departments but trolley numbers have come down by about 22% nationally. What is critical is patient flow within hospitals and discharge policies. I know the HSE has been in touch with Cork University Hospital in respect of patient flow and discharges and there have been some improvements. We saw at Waterford hospital how locally approved and applied policies had a very effective outcome in respect of delays.

No patient should be 100 hours on a trolley and that cannot be just apportioned to national allocation of funding. In my view, no elderly person should be 100 hours on any trolley. There are issues there that are not just about national allocations of funding. We need reforms of how patient flow and discharge are managed. In addition, we need extra capacity, and we have increased ICU capacity by 24% since we came into office and increased the number of beds. There are very significant capital proposals and projects in the pipeline for Cork University Hospital in terms of surgical hubs and a new paediatric unit. We have already had significant investment in that hospital in this respect and we need to do more. We have received proposals in respect of a number of significant projects, including trauma, which we approved. This Government, for the first time, has a major trauma investment programme, which has included Cork University Hospital, along with the Dublin hospital, because Cork is a major trauma centre and one of the largest in the country from that perspective.

We will continue to invest. In the OECD Health at a Glance report comparing Ireland with other EU member states, we ranked second-highest in the OECD for practising nurses per 1,000 population and 12th-highest for practising doctors per 1,000 population among 25 participating EU member states in 2021. That figure has since gone up. We need to put this debate in perspective. Very substantial resources have been allocated to health. The population has increased, which I acknowledge, but along with and in parallel with increased resources, we have to consistently look at how we organise our hospitals in terms of ensuring reforms across the board into the future.

I will say that the Government does not care because a government that did care would actually listen to the ESRI when it says we need 1,000 more beds now.

The Department of Health has a plan for those beds. The problem is that the Government, of which the Tánaiste is a part, made a decision not to fund those beds. There is no way you can slice, dice or spin it around. The Government made a conscious decision not to fund the additional beds. Then the Tánaiste says nobody should be on a trolley for 100 hours. The reality is that in many of these hospitals the bed capacity is simply not there and the Government is making conscious decisions not to allow the Department which has gone out to tender to actually ensure that these beds are in our hospitals in the future. You cannot have it both ways because this rests on the Tánaiste's shoulders. The Government has missed its targets on trolleys and waiting lists and it is blocking the funding for the additional beds that the Department wants to deliver. That is the reality of it. Professor Conor Deasy, not Sinn Féin, is saying that this is costing lives. Other professors are telling us that our hospitals are running at 300% capacity on the Tánaiste’s watch. The hospital in his county is running at that and he is telling us he is doing everything. He is not. What we need is a multiannual plan. We need the Government to allow the Department of Health to fund the beds that are needed and to lift the recruitment embargo to ensure that the staff who are needed in our hospitals are actually recruited. That is a government that cares. I put to him to do those three things and then I will stand up and say, “Yes, this Government does care”.

First, the Deputy’s analysis is wrong, actually. We need a multidimensional approach to healthcare. The Deputy is falling into the old trap. It is about tertiary hospital capacity for him but actually it is not. That is an important part of it but it is about building up community care and primary care. I attended Ballincollig primary care centre two weeks ago. It is a fantastic multidisciplinary facility. It deals with eye diagnostics and treatments, mental health treatment, chronic illness and a whole range of disciplines which will prevent people in the first place -----

It is a well-worn tactic to interrupt me every time I respond. There was very significant investment in Gurranabraher in primary care and enhanced community care. We have to be very careful that we do not lose out on the huge momentum that is being built up in terms of community and enhanced care and primary care because that ultimately helps to keep patients out of emergency departments. Many patients can be treated through these services in a much more effective way, working in an integrated way with the hospitals and with tertiary care. There is no question about that in terms of outpatient care and various treatments that can be done and in chronic illness.

We are not. We have increased the number of beds by over 1,000. CUH, two or three years ago, was a bit slow in making submissions on the capital projects. There is new governance there now. The projects have come in. The Deputy does not have to lecture me about Cork or investment at Cork hospitals. I was the Minister for Health. It is the only hospital that has a maternity hospital on site with a tertiary hospital because the investment I made over 20 years ago along with a lot more as well.

Last night this Government voted against supporting South Africa’s case against Israel in the International Court of Justice at the earliest possible opportunity. Instead it amended the Social Democrats motion to say the Government will only consider supporting the case at some point in the future. We now know the preliminary ruling is due tomorrow. But even then the Government has said it will not act and that its decision will only be made after South Africa submits its substantive case. Am I right in thinking it could take six, nine or maybe 12 months for the Government to make up its mind?

People want to know what is going on here. The Tánaiste has not been slow to use the word “genocide” before. Less than two months after Russia invaded Ukraine, he accused it of genocide. He did this while he was Taoiseach. He made an assessment that there was a risk of genocide and demanded that Russia be held to account, and it was. The Irish Government worked with the international community to freeze bank accounts, impose trade sanctions and set travel bans. The sanctions against Russia were rightly agreed within weeks. What consequences has Israel suffered for its actions in Gaza? Can the Tánaiste name even one?

I listened to the Tánaiste speak earlier this week when he said Israel has to be held to account. In what way? By whom? Because every time the Social Democrats and others have suggested ways that the Government could hold Israel to account, he refuses to act. He will not indicate support for South Africa at the International Court of Justice, he will not refer a case to the International Criminal Court, he will not lobby for economic sanctions at EU level, he will not withdraw the diplomatic status of the Israeli ambassador and he will not pass the Occupied Territories Bill or the Illegal Israeli Settlements Divestment Bill. I am asking the Tánaiste to please not use his time to explain to me what the ICJ is and how it works. I know that.

I am asking that he signal his intention and start the preparatory work to intervene now because we all know that you do not signal your intent and walk into the ICJ tomorrow. There is a lot of work that goes on in advance of that. When bombs are being dropped indiscriminately in densely populated areas, a man-made famine and aid cannot get in and when 250 people are being killed every day there is no time to waste. This wait-and-see approach is not proportionate to the atrocity that is unfolding in front of our eyes. It is not reflective of the strong feeling around the country and it is not even representative of the Tánaiste’s own words on this issue.

I have welcomed this Government’s and the Tánaiste’s strong words of condemnation against Israel’s massacre but what everyone wants to know is will he match those words with actions, not at some undefined time in the future but now.

I have three questions. Does the Tánaiste believe that a genocide, or risk of genocide, is occurring in Gaza? Can he explain his divergent approach to Russian and Israeli war crimes? How is this Government going to hold Israel to account?

We have been very consistent in calling for an immediate humanitarian ceasefire. We were one of the first European Union countries to come out and call, and rightly, for an immediate humanitarian ceasefire and for unimpeded aid to go into Gaza, which are the two most urgent things that have to happen. Third is the release of all hostages that are being held by Hamas and then to get into a political peace track.

The Deputy asked a question and then tried to tell me how to answer it. I do not propose to go down that line because I do think there is a fundamental disingenuous approach being adopted by the Opposition in respect of this case and this issue. First, the Deputy asked how is Israel held to account. In the courts. We are already before the International Court of Justice. Ireland has already submitted a legal submission in respect of Israeli occupation of the occupied territories, the West Bank and so on. The Attorney General will be participating in a full hearing in February. I oversaw the submission of a very robust legal case that we had made to the court in respect of the breaches of international humanitarian law that we believe has happened in the occupied territories. So Ireland is active before the courts where accountability matters. Likewise, we have supported the international criminal court in respect of the case that Palestine has taken against that court and we have followed it up with significant funding which is what the prosecutor wanted. We gave an additional €3 million to the court to enable the court to have the resources to deal with that case and other cases it is dealing with. That case is active and it is prosecuting all actions from 7 October until now.

In respect of South Africa, no country has joined -----

It is creating false perceptions.

Outside, people looking in at Ireland say that Ireland is pro-Palestinian and pro a Palestinian state. That is what people see about Ireland. We are having an internal debate here. Certain parties seem to be trying to say that they are more virtuous than the parties over here in terms of how much they care about the cause of Palestine.

It is very cynical. It seems to be more about leveraging electoral and political advantage for themselves than about an objective and rational assessment of how we proceed. In terms of intervention, the point is that we cannot intervene until we know the basis of the case. Our approach to this is exactly the same as our approach to Ukraine. Ukraine was refuting Russian allegations, which were the basis for its invasion, that it had committed genocide in the Donetsk and other regions. Ukraine refuted that. Ireland joined months later, by the way, following the preliminary hearings at the court.

Speaking down the clock and talking about how I am apparently being disingenuous really says it all. I literally said at the beginning that the Government voted down our motion, which called on it to intervene "at the earliest possible opportunity". I literally highlighted, in my speech just before the Tánaiste spoke, that we want the work to start now. We do not signal our intent and walk into the ICJ tomorrow. There is preparatory work that needs to take place. We are calling on the Government to do that now - to intervene "at the earliest possible opportunity". The Government amended our motion to say that it might intervene at some undescriptive time in the future. I was not disingenuous. Word for word, that is what our motion said. The Government amended it.

When I ask the Tánaiste about the Government's actions, the only thing he can point to is securing travel bans for violent settlers. I want to give people an idea of how relatively inconsequential that is. Given that America, which is one of Israel's biggest allies, introduced those bans at the start of December, it is hardly a legitimate action in the grand scheme of this entire situation. It is clear the Tánaiste will not answer the questions I asked. I will go back to one thing, and I ask him to respond to this. He said, without hesitation and without equivocation, that there was a genocide happening in Ukraine. Will he use that same language to describe what is happening in Gaza?

Going back to the court case, states that consider they have a legal basis for intervention in the ICJ must seek the court's permission to intervene. This is typically done in all cases. Nothing new is happening here. It is typically done after the court has made any provisional measures orders. The court is now saying it will deliver that tomorrow. What are the provisional measures South Africa has sought? It has sought an immediate ceasefire and unimpeded humanitarian access, both of which we agree with. We agree with everything South Africa has sought from the court in terms of provisional measures. We have been seeking these in advance. Then South Africa has to file a memorial, which is the substantive case. We anticipate it will share that with us. That will provide us with the basis to legally intervene. The court is not a political chamber. It is not a debating chamber. It is about arguments that speak to the convention and enable us to actually successfully prosecute a case at the convention. That is the distinction we are making and that is exactly what we did. Ireland intervened in Ukraine's refutation of Russia's allegation of genocide against Ukraine five months after the provisional hearing was provided. I am extremely concerned about what is going on. I have already called out announcements by two Israeli government ministers that I believed were genocidal in their content in terms of calling for displacement of Palestinians and the elimination of Palestinians from Gaza.

I was not going to bring this up today but I will do so because we are in the year of elections. Today we have announced the wordings for the referendums to take place on 8 March. Particularly in light of the last Leaders' Questions, when someone was accused of being disingenuous, I would like to speak about falsehoods. People want to know what stance our political and party leaders are taking on the individual and community-based fake profiles on our social media platforms. The number of fake profiles now evolving, as individuals and as community-based profiles, is actually staggering. The policy is what we are asking for. What is Fianna Fáil's policy on potential candidates or already elected Fianna Fáil representatives who are using fake profiles - individual profiles, community-based profiles, or both - to promote their electability? In many instances that have been reported, this is being done at the expense of what are now criminal acts under Coco's law, and represents defamation in civil law. Does the Tánaiste, as leader of Fianna Fáil, condone candidates who hide behind fake profiles? That is what people are asking. Does he agree that a core issue for any elected representative must be honesty and transparency? What sanctions would the Tánaiste deem fit to apply to any elected representative or potential candidate who is found to use fake profiles? What would the sanction from his party be if he was to become aware, or if he is aware, of Fianna Fáil candidates who hide behind individual or community-based profiles?

If the Deputy is suggesting that somebody is doing this, maybe she should call it out, if there is validity to it. More generally, public representatives should be upfront and transparent in their communications. In my view, no public representative or political party should be creating a bot machine, or a whole series of approaches that facilitate trending and the creation of false news or misinformation.

In whatever legislation emerges, there will have to be a balance between the right to free speech, the right to proper debate and the need to avoid undermining our democracy and our electoral system. That is why the Electoral Commission, which has now been established, has been given specific powers in respect of online manipulation and online misinformation about people and politics. In the context of a general election campaign, in particular, the chance for an individual or political party to respond is limited. The damage can be done before polling day if fake profiles, or misleading information with regard to policies or initiatives, are put up. We saw that in an election in the United States some time ago, when outrageous and false allegations with regard to emails were made in respect of Hillary Clinton and gained traction during that campaign. We have given powers to the Electoral Commission to - at a minimum - call out any untoward action that is wrong and could influence people in the wrong way, particularly when it comes to trending stories and so on.

In a recent case, I was portrayed as supporting an investment product in particular advertisements. What concerned me was that I had to go to the courts to seek an order from Google as to who was behind those advertisements. No one should have to go to court to find out who is behind advertisements or material that is defamatory of an individual in the first instance, and in the second instance could mislead ordinary citizens into losing their money or investing in false products or scams.

There is an evolving situation, generally, in terms of the issue the Deputy raised. To come back to her fundamental point, we are elected public representatives. I do not understand the rationale, or why anybody would want to do this. Normally it is the opposite, if I may say so. Most people here are not shy in seeking publicity and making sure their photographs and titles are in the press releases and various postings that are online. It is a new departure. I understand some people might want to try to do something behind the scenes. That is not right in my view. Public representatives should be transparent, upfront and open.

I thank the Tánaiste. The only question that was asked was whether Fianna Fáil has a policy with regard to its own elected representatives. The Tánaiste did not tell us what that policy is. That is what people want to know. Is there a sanction for Fianna Fáil's elected representatives? The Tánaiste said he was the victim of such a profile and had to go to the courts.

Would it not be best to start at home with Fianna Fáil's own elected representatives and tell people how the party sanctions them and candidates who are going to face the electorate? The party supports the hate speech Bill, which will sanction society over the types of thing its potential candidates and elected representatives are purporting and spewing online while hiding behind individual and fake community-based profiles. People want to know what Fianna Fáil’s policy is on keeping its own elected representatives in line in this regard. The Tánaiste accused my colleague of being disingenuous, but if Fianna Fáil is promoting the hate speech Bill, it is disingenuous to try to blame wider society when it cannot start at home. I am asking about Fianna Fáil’s policy on sanctions.

The Deputy has just thrown something out there into the ether, which is not a very honest way of doing things. If she has a problem with a particular person, say it to me. Say it to the Fianna Fáil Party. We have commented on other tweets about situations that we found unacceptable. That happens across all parties and individuals. There is a policy and a disciplinary process to deal with it.

One of the key promises that the Government made in advance of the last election was around housing and its delivery. It would be churlish not to acknowledge that there has been a big increase in the amount of housing coming on board. I think we are at a 15-year high. Social housing is also being built, albeit not at the rate that the Government and I would like to see.

However, there is a cohort of people caught in the middle and not being helped, a cohort without whom we would not have this State. In Clare, the threshold for social housing for a single person is €35,000. The lowest level of earnings that someone can obtain affordable housing on under any of the affordable housing schemes in Clare is €55,000, yet there is a large group of people in between the €35,000 and €55,000 who have little hope of getting a home. For example, the first point on the Garda incremental pay scale is €35,322, primary teachers start at €40,625, secondary teachers start at almost €2,000 more, nurses’ entry level is €39,000, local government branch librarians or clerical officers start at €27,000 – in theory, they could qualify for social housing – and the starting amount for a lab analyst is €37,000. As such, a large cohort of people do not qualify for social housing but cannot avail of affordable housing. What will the Government do in its remaining time to give them hope? We worry a great deal about people emigrating, and there is a variety of reasons for them doing so. For example, there are people who emigrate to experience the world and come back. However, one of the reasons young people cite for emigrating is that they cannot realistically hope to buy a house on their starting income levels after completing their education. What does the Government plan to do for these people?

I thank the Deputy for acknowledging that there has been an increase in house completions. The Central Statistics Office indicated today that 32,695 houses were completed in 2023. That is a 10% increase on 2022, which saw a 45% increase on 2021. The momentum on house building is in the right direction. Without question, Covid held us back. Over 100,000 houses will have been built since this Government came to office and we are making significant progress, but we need to do more. What was significant in the CSO’s figures this morning was the increase in the number of apartments completed in 2023, namely, 11,642, which was up 28%. The importance of this is that we were grappling with the viability question in respect of apartments. The waiving of development levies and other measures that we took last year are having an impact on the increase.

The Deputy has raised a fair issue. The number of first-time buyers is way up. The help-to-buy and first home schemes are helping many people who are buying at different price ranges. People have also shown huge interest in the vacant housing grants, which amount to €50,000 and €70,000, respectively. These could cover some of the people in the cohort that the Deputy referenced. Each week, approximately 500 first-time buyers are buying their first homes and approximately 29,000 first-time buyer mortgages were approved in the first 11 months of 2023. There is increased momentum and we are going in the right direction in terms of housing supply, but we need to do more and progressively increase the numbers. This year, I hope that we can go higher than the figure of nearly 33,000.

We increased the income threshold for local authority housing and social housing by €5,000 last year, but the Deputy has pointed out the gap between that and some of the affordable housing schemes. I do not know whether the Deputy is factoring in the help-to-buy scheme or the first home scheme. We also have the cost-rental scheme, which has proven effective. It is a new model that was really only introduced in the past two years, but it is gaining traction all the time. It results in rents of approximately 25% below the market rate. We will continue to innovate to see whether we can enable as many people as possible who want to buy their own homes to do so at an affordable price and within their income range brackets.

I appreciate the figures the Deputy has tabled in respect of income levels. Interestingly, and to bring in another debate, Defence Forces personnel compare favourably with some of the other starting rates the Deputy outlined, given the increases we have allocated in recent years.

I acknowledge the challenge the Deputy has outlined. We need to work on developing schemes that can be applied to people in that cohort.

There is a question mark over whether Covid held the Government back or whether the Government’s response to Covid and the regulations it introduced regarding house building specifically held the situation back. People could not put a roof on a house down a rural road without gardaí being called. It seemed ridiculous at the time, but I do not want to digress into that discussion.

I acknowledge that houses are being built and the number of first-time buyers is increasing, but what of the squeezed middle? When I grew up, people who worked in the local chipboard factory, which was the big employer, could get a council house. They could move into that house with their family and say that it was the home in which they would bring up their families. Young gardaí, teachers, nurses, local authority employees and civil servants who are starting out now do not have that possibility. That is the cohort I am specifically asking about. They are caught between the income they need for affordable housing – income levels in the Defence Forces may be increasing, but such housing is still beyond the reach of its personnel – and the level at which they can get social housing. The latter threshold has been increased, but it still leaves a huge gap into which ordinary people fall. We talk about our State, but without these people, it cannot exist. They cannot hope to move into a house and call it their own in the Ireland of today. Notwithstanding the advances that the Government has made in the provision of housing, those advances are for people with a lot of money, and we do not pay these people on whom our State relies a lot of money, at least when they are starting out. Maybe we do after ten or 15 years, but they are almost middle-aged at that point.

That is the problem.

It is possible in Clare for people in the areas the Deputy identified to purchase homes, particularly with the support of the help-to-buy scheme, the first home and various grant schemes and the local authority home loans that have been made available. It is improving. I know of people in exactly the categories the Deputy mentioned who have managed to purchase homes in the past year or two.

The majority are double-income families. No question, and I acknowledge that. The Deputy makes a fair point in that regard. It is a combination of factors, but there has been huge take-up in respect of the help-to-buy scheme. The first home scheme is particularly geared towards trying to help people bridge the gap in the context of what a house costs, with the State providing equity to make up the balance in order to enable people to afford to buy homes. We will continue to work at it.