Mattie McGrath (Tipperary, Independent) | Oireachtas source

I am happy to speak on this Bill which seeks to give effect to the taxation changes announced on budget day. Section 2 of the Bill provides that the reduced rate of universal social charge for full medical card holders whose individual annual income does not exceed €60,000, will be extended for a further year until the end of the 2020 tax year, which I welcome. We know from the ESRI that income tax, including the universal social charge, is the largest individual source of tax revenue in Ireland, accounting for more than 35% of the total. Thus, fluctuations in this source of revenue have a significant bearing on the total tax take.

As the Minister was at pains to say, the budget and Finance Bill were framed with an eye or two looking over our shoulder at what was happening across the pond in England regarding Brexit. Nonetheless, I believe the budget lacked any form of imagination or real effort to look after ordinary people or families.

I want to speak about the broader health-related measures being introduced. The Minister is providing for a €25 increase in the weekly income threshold for GP visit cards and a 50 cent reduction in prescription charges from €2 to €1.50 for all medical card holders over the age of 70. There will also be a €10 reduction in the monthly drugs payment scheme threshold from €134 to €124. All these moves are welcome even if we believe far more ambitious movement could have been made on each of them.

I ask for some clarity on whether funding has been considered that would enable us to waive or reduce the fees for accident and emergency care for children who suffer from conditions which necessitate regular attendance at hospital accident and emergency units. This is very important because if one has a sick child who is prone to becoming seriously ill quite quickly, one needs to be able to access accident and emergency units and have these charges waived. We had a situation where a 74 year old woman was knocked off a trolley by a drunk. Something has to be done about these people, who are drunk, on drugs or whatever, causing mayhem and bedlam. We have to pay security to try to protect our front-line staff who must be protected. We will have to consider taking those people elsewhere. I have an idea where I would send them, particularly if they are repeat offenders. They take up Garda, security and everyone's time. The terror they perpetrator in the accident and emergency unit, in the hospital and on the patients, young and old, is not acceptable. We should not be pussyfooting around this issue and we should deal with these people. They are repeat offenders who do not seem to care what kind of mayhem or bedlam they cause. They may be hell-bent on damaging their own lives. I am not saying to lock them up and throw away the keys. What I am saying is that we need to protect our accident and emergency units which are under extreme pressure and we should deal with the people we need to deal with.

When I raised this matter with the Minister, he said that the Health (Out-Patient Charges) Regulations will continue to insist that the charge shall only made in respect of the first occasion the service, that is, where a child goes to an accident and emergency unit, is provided in respect of each episode of care.

It is not. There is no clarity. They are being charged. I would like to see budgetary discretion in terms of a full waiver for those who simply cannot afford the fees. If they are that sick, they have to go to an accident and emergency department.

The Minister announced that an additional €84 million will be provided for mental health services in 2019, bringing the total available funding for mental health to €1 billion, representing an increase of 9%. Deputy Healy is in the Chamber will be speaking afterwards. He will realise the mental health service is appalling. For several years, the full budget has not been spent where it was supposed to be. Very little of the €1 billion must be making its way to Tipperary as the county is still without a single residential psychiatric bed. Our crisis house is still not being provided for adequately. There have been many promises but we cannot live on promises. We cannot live on the wind. The people of Tipperary are entitled to some mental health services, just like any other place in the country. It is a scandal that we do not have any place for patients to go. When they have a psychotic episode or feel bad, they have to go to an accident and emergency unit. We cannot even get a seomra. There is not even one 8 ft by 8 ft room in a hospital accident and emergency department. There are 40 new modular units but we cannot get one of them for those who are not allowed to sit in an accident and emergency department, with the associated trauma and triaging. For their own health and sanity, they must be allowed to be in some place that is less stressful, busy, noisy and devastating. There are cases of individuals who were sent away from accident and emergency units and sadly ended up in the grave. Accident and emergency services are not able to cope. We lost our psychiatric services in St. Michael's in Clonmel. We lost St Luke’s before that. We need some service. Lip service is all we are getting.

The Minister of State at the Department of Health, Deputy Jim Daly, is doing his best but his best is not good enough because he cannot deliver. He is frustrated. It is accepted in all the HSE areas that we are short of at least 12 to 15 long-stay beds. We do not have a single bed. We are sent to Kilkenny. It is a case of saying, "To hell or Kilkenny." It used to be, "To hell or to Connacht." Kilkenny cannot cope with the numbers from the south east. In north Tipperary, patients are sent to Ennis, by-passing Limerick. We are almost in Connacht at that stage so the phrase "To hell or to Connacht" is very apt for this Government. It does not care about the people. It must look out for them because they are the most vulnerable and the ones who need care. All they may need is a small bit of counselling. As Dr. Alan Moore and others have stated, if we could provide the 24-hour specialist nurse service, much of this could be avoided. Patients could meet the specialist nurse, who would understand their predicament and be trained to deal with them. I am told the staff are ready, willing and able and have been accepted for the job but there is no money to pay them. Where is the €1 billion going? The Government is playing a trick of the loop here. It is too serious for that, especially when mental health is concerned.

I understand from the Minister that the total funding for the National Treatment Purchase Fund will be €75 million in 2019. This must, however, be seen in the context of the 564,829 patients who were waiting for a hospital outpatient appointment at the end of July. This represents an increase of 4,578 by comparison with the figure for June, according to the data from the National Treatment Purchase Fund. Has the Government any shame? Is it totally shameless? The number is growing continually but the Government claims credit in the Dáil for what it is doing with the economy. If it cannot look after the people who are sick, God help us. As I understand it, the proportion has increased by 10.4% year on year, with 511,675 patients on the list this time last year. Since the start of 2019, an additional 48,667 patients have joined the waiting list. This is incredible and beggars belief. Each figure represents a real person with real health issues. This is absolutely scandalous, especially when we consider that the 2019 capital provision for health will amount to €670 million next year.

Individuals in need of HSE home care are waiting more than two years in some cases. It is reported that pensioners are now finding it more difficult to access home care than a decade ago. One million additional hours were announced in the budget but they will go nowhere. They will not even keep us standing still. We need 3 million. The problem now is that we cannot get staff to provide the care because they are fed up of being burned out and running around the country in their own cars trying to get from Billy to Jack to Ned to Tom to Mary in the same two hours, devoting perhaps 20 minutes or half an hour to each. The staff in my area are doing their best but they just do not have the go-ahead. Where a package has to be approved, there is no clarity. There is a recruitment ban and the Government is hiding behind it. This has been confirmed previously through an investigation conducted by Care Alliance Ireland. Care Alliance Ireland's executive director, Mr. Liam O'Sullivan, has estimated there is a gap of 18%, or 4 million care hours, between what is needed and the service people receive. What are we doing to the people who built up this country and gave us all the bloody breath that we can breathe and gave us a living here? What were we doing celebrating the 100th anniversary of our sovereignty with the Ceann Comhairle in January? My goodness, it is shocking. What has the Minister provided in this Bill that will prevent this awful situation from getting worse? We pay lip service to carers. Families need them. They free up hospital beds.

I am relieved that the Bill provides for the continued extension of the young trained farmer stamp duty relief, but only until the end of 2021. This relief provides for a full exemption on stamp duty on transfers of farmland to certain young trained farmers. This exemption from stamp duty is designed to encourage the transfer of farmland to a new generation of farmers with relevant qualifications. The transfer may be by way of gift or sale. Getting younger farmers involved and keeping them interested are badly needed. In order to be eligible, the farmer must be under the age of 35 on the date of the deed of transfer and must also have attained one of the necessary qualifications. That is fine. The young trained farmer must also spend not less than 50% of his or her normal working time farming the land and retain ownership of the land. In my county, Tipperary, they cannot do so because a to-hell-or-to-Connacht policy is being operated.

In my budget submissions over the past five years, I have asked the Government to impose a massive tax on the conglomerates, one of which is in the horse industry in my area. We have a wonderful horse industry that we are very proud of. The conglomerates must not be allowed to buy every perch of land. In my area, a conglomerate is buying everything the size of the carpet in the Chamber. This gives no chance to any young farmer. Admittedly, the conglomerates will throw money at communities and support the GAA and soccer clubs but this is false economy because if we do not have farm families and people living in the area to support the villages, we will be wasting our time. We will not have schools or the numbers to make up teams. We will not have any living. Those concerned have fenced the lands, bulldozed ditches and trees all the land, bulldozed ditches and trees and fenced people out. A snipe would not get through. In the days of the old landlords, the farmers and the workmen got milk and all kinds of food going home. Not a snipe would get through. There are security gates with flashing lights. Three or four massive combine harvesters roll in and security is hired to mind them. The Government is in hock with them and supporting them. The members of the Government were all bussed down to Mallow when they took over in 2011. They were brought over around Coolmore and looked after for two days. The conglomerates have deep pockets and the members of the Government are inside them but, my God, the people are waiting to see them.

See this speech in context