Wednesday, 27 November 2013
The figures published by the National Treatment Purchase Fund last Friday show that waiting lists for hospital procedures and treatments have increased by about 18.6% year on year, that is, an increase of about 7,764. The various categories show that the number of people waiting more than three months has increased by 32%, from close to 20,000 up to 26,200; the numbers waiting more than six months has almost doubled from about 6,000 to close to 12,000; and for the numbers waiting nine months and more there has been an incredible increase of about 4000%, from 107 in December 2012 to 4,400 in September 2013.
Equally, for children there has been an astonishing increase in waiting lists of 50%, up from 2,900 to 4,448. The list for children is compounded by the number of children waiting for outpatient appointments. There are now 40,000 children waiting for outpatient appointments in the country, 33,000 of whom are in Temple Street Children's Hospital and Our Lady's Children's Hospital, Crumlin. We know that a letter has issued from the CEO of Our Lady's Children's Hospital, Crumlin, and other CEOs stating that patient safety is compromised and will be further compromised if the scale of budget cuts announced on budget day materialises. In essence, what has happened was that when the Minister came to office there was much fanfare, spin and change. He repeatedly undermined the National Treatment Purchase Fund and essentially pulled the rug from under it. He set up the special delivery unit, appointed an independent CEO, who left the job a year early and the figures have become much worse. Does the Taoiseach agree that these figures are unacceptable, particularly for children, and what does the Government propose to do to reverse significantly the trends that have emerged in the past 12 months?
This is always a matter of concern and a topical debate. Since the special delivery unit was initiated in July 2011, significant progress has been made in a range of areas resulting in reducing the number of patients on hospital trolleys and on waiting lists. By the end of last year there was a 98% decrease in patient day case waiting lists over nine months, a 95% decrease for children waiting 20 weeks and a 99% decrease for routine endoscopes more than 13 weeks over the year. For a number of reasons, the early months of the year have always brought exceptional pressure on these lists, not the least of which was referred to by the Minister, after some analysis, that this was due to a failure to provide cover when people are away on holidays. The Minister for Health set a target to eliminate the waiting list for all inpatients over eight months by the end of this year. As a result, the increase in 2013 was certainly much greater than expected, with a 16% increase in total numbers waiting between December 2012 and December 2013. However, through the sustained intervention of the special delivery unit this trend is now reversed with a 5% reduction in total numbers waiting and a 42% reduction in the numbers waiting more than eight months since the end of July 2013. As of 21 November 2013, 3,393 people are waiting more than eight months.
A range of responses are being taken, such as using an €18 million intervention fund to meet the targets; developing and monitoring a number of special plans with hospitals where the elective waiting lists are under pressure; identifying increased capacity and capability across hospital groups - some surgeons and consultants tell me they have got spare capacity in their hospitals and said they can take some off the long waiting lists; increased operating theatre lists; a national analysis of risks impacted on hospitals; speciality level performance and so on. The electronic data collection commenced in March 2013. Material provided by the HSE indicates that between 28 March 2013 and 21 November 2013, there was a 5% reduction in total numbers waiting, a 41% reduction in numbers waiting more than 12 months, a 34% reduction in numbers waiting between 12 and 24 months, a 40% reduction in numbers waiting between 24 and 36 months, a 56% reduction in numbers waiting between 36 and 48 months and an 87% reduction in numbers waiting 48 months plus. The direction given by the Minister was to deal as a priority with the cases that are waiting longest. The Deputy may shake his head. If he wants to dispute the evidence, he may do so, but this is the electronic data collection commenced by the Minister in March 2013. If it is wrong, please prove it.
The outpatient lists are shocking. You undermined repeatedly the National Treatment Purchase Fund by taking the funds from it and putting them into the special delivery unit and the result is that there are far more people on the waiting list.
This is the total volume of inpatient and day case people waiting for procedures in our hospitals. I did not publish these figures. The National Treatment Purchase Fund published them. Please do not try to undermine them by more spin and trying to camouflage the reality on the ground for children and people who are waiting for badly needed procedures.
The bottom line is that when the Minister, Deputy Reilly, came to office the National Treatment Purchase Fund had clear targets - six months for adults and three months for children. The Minister invents the 12 months target and gets rid of three months and six months and gets away with it for a year by essentially falsifying the message and the presentation of the message.
The bottom line is that it has come through. Some 107 were on the waiting list in December 2012 for nine months and more while the number is now 4,473. That is not my figure, it is the figure from the National Treatment Purchase Fund. There has been a 97% increase in the number of people waiting nine months and more, according to the National Treatment Purchase Fund. The position regarding children is shocking in terms of inpatient and outpatient lists for Our Lady's Children's Hospital, Crumlin, and Temple Street Children's Hospital. The National Treatment Purchase Fund figures show that the numbers of children on waiting lists has increased by 50% and there are more than 40,000 waiting-----
What is the Taoiseach going to do to change tack, stop all he spin and the presentation, and the undermining of the National Treatment Purchase Fund that has happened in the past two years? The result is that there are more people waiting for longer times than every before.
Of course, the Deputy ran a mile from it himself when he had responsibility for this area. At least the Minister, Deputy Reilly, has faced up to the challenge and is doing something about it. For 2013, as set out in the HSE service plan, the target maximum wait for inpatient and day case procedures is eight months for adults and 20 weeks for children.
The waiting time for a routine GI endoscopy procedure was 13 weeks at the end of September. The figures have now been published on the website. The total number of people waiting is 49,496. A total of 11,939 people or 24.1% are waiting over six months. Of those waiting over six months, 4,473 are waiting over nine months. Of those waiting over nine months, 934 are waiting over a period of 12 months. This is not satisfactory but it is an improvement on the situation that applied before.
In respect of emergency department trolley waiting times from 2011 to 2013, an analysis demonstrates there was a reduction in the number of patients waiting on trolleys for admissions. There was a 22% reduction between 2011 and 2012, a 12% reduction between 2012 and 2013 and a 32% reduction in the number of emergency department patients between 2011 and 2013. For the year 2012-13, the analysis demonstrates that for the week of 18 to 24 November this year, which was a reference week identified by the Fianna Fáil spokesperson on health, the reduction in the number of patients waiting on trolleys for admission for 2012 was 1,139. Between then and 2013, the figure was 950. The week of 18 to 24 November represented an overall reduction of 20%. These are things that obviously change depending on the nature of the health business. The national trolley count average value is based on the INMO trolley count undertaken five days a week with one measurement a day at 8 a.m. I have given Deputy Martin the inpatient and outpatient figures. We want to continue to improve them. As Deputy Martin well knows because he failed to do so, this is not something that will be sorted out overnight but I am glad to say that the people who work on the front line of these services do an extraordinary job and continue to do so. The Government will continue to work with the Minister for Health to see that these waiting lists are reduced. As I pointed out to Deputy Martin, they have started with those left lingering on waiting lists for three, five or seven years in some cases because the previous Government ran away from it and did not touch it.
The homelessness crisis in our capital city is getting worse. Walk the streets around here and one will see countless people, many of them very young, sleeping rough. Imagine what it must be like to be forced to sleep on the streets night after freezing night. This week, the Dublin Region Homeless Executive confirmed that rough sleeping in the city has increased by a shocking 200% in the past 12 months. This morning, Focus Ireland reported an 18% increase in demand for its services this year. Many other homeless agencies are experiencing similar demands. They have also highlighted the fact that the number of families presenting as homeless in Dublin has doubled from eight to 16 every month.
This Government is responsible for this crisis. Its austerity policies are forcing families out of their homes and on to the streets. Its cuts to social housing budgets have meant that councils simply do not have the houses to ensure that nobody is forced to sleep rough. When is the Taoiseach going to take this homelessness crisis seriously and when does he propose to release the funds to give sufficient funding to ensure that no family is forced to sleep rough or live in emergency accommodation?
This is not a simple matter to sort out either. I spoke to somebody on the street the other night from a county outside Dublin who had had a row with his spouse, was on the streets and, according to himself, will be on them for a couple of weeks. At this time of the year, this issue becomes much more of a focus both for agencies dealing with it and because of the time of the year when the weather is deteriorating. I understand that one figure referred to recently relates to the number of unique individuals in contact with the regional contact and outreach service over a six-month period who were sleeping rough for one night. It is not a measurement of the number of people sleeping rough on a given night. Rather, it is an assessment of those who are entering rough sleeping over a six-month period or who may for a number of reasons have left an emergency accommodation bed.
I also understand that what is known as the rough sleeper count, which is twice-yearly, was last conducted in April 2013 and revealed 94 rough sleepers in the Dublin region. I understand that the figures from the recent November rough sleeper count will be available in a short period of time. I notice that many of the people commenting who work for the agencies indicate serious increases in people who are homeless or on the streets. I understand that some of these are based on telephone calls to some of the agencies. I am not sure how accurate this is. I am not decrying the figures they put out but there is a requirement to get an accurate focus on what is happening in Dublin. Some of them indicate to me that the numbers go up by five or six per day. If that is the case, there is clearly a spiralling element of homelessness.
The Minister of State with responsibility for housing is obviously interested in dealing with the housing situation and shortage in so far as we can. A Deputy from Dublin pointed out to me a number of vacant and derelict houses and units in her constituency which have not been attended to for quite a long time by Dublin City Council for one reason or another. The homeless policy statement published this year outlines the Government's intention to end long-term homelessness by 2016. That statement emphasises a housing-led policy that is about accessing permanent housing as a primary response to all forms of homelessness. That is the focus of Government policy. In 2012, in the Dublin region alone, 879 people moved from homelessness to independent living. I recently visited the unit at Merchant's Quay and spoke to some of these people who have moved to independent living and have been very happy with the move they have been able to make despite all the personal difficulties they have had.
I agree that economic circumstances placed huge pressure on so many individuals and families. The Government supports this with a budget of approximately €45 million in 2013. That funding maintains services across the country. It is matched by local authorities with a contribution of at least a further 10%. The bulk of the funding provided by the Department of the Environment, Community and Local Government goes to funding services by voluntary providers such as Focus Ireland, the Simon Community, Crosscare and the day care drop-in centres and outreach services. They all do very intensive and committed work. The Minister for the Environment, Community and Local Government is committed to implementing the homeless policy statement and is determined to work closely with other State and voluntary organisations. We discussed this the other day here in one of the committees I chair so I am interested to see verification of the real numbers and how quickly we can make an impact on this. Based on the rough sleeper count I have given the Deputy, they are the figures I have. The figures from the second rough sleeper count conducted in November will be available very shortly. I agree that it is not a situation that anybody wants to stand over. I asked a homeless person the other evening about what he does with all the gear he was carrying. He told me he leaves it in a particular spot during the course of day and goes around to his usual haunts to see if he can make ends meet. That is not a satisfactory situation. Some people with whom I speak have a range of problems, as the Deputy is aware. Despite the best intentions of many voluntary organisations, some of them do not want to go into housing or emergency housing. Some people want to stay on the street for their own very specific reasons. That is a difficult situation. When I was first elected here in the 1970s, there was a lady across the road who did not want to into permanent accommodation despite all the efforts that were made.
I am not really sure what to make of that answer because the Taoiseach is speaking out of both sides of his mouth. It seems that he is seeking to strike a sympathetic note without committing himself really to doing anything to change the situation.
In case the Taoiseach is in any doubt-----
Families are left in bed and breakfast accommodation or hotel rooms, some of them for years. They do not want to be there. They want proper accommodation. The thousands of people on housing lists want their own homes. They want that basic security. This is not just an issue of rough sleepers, although that is the sharpest end of the homeless crisis. I accept that parts of homelessness are complex issues for the person in question, but in policy terms all of this is quite simple. There is nothing complicated about a 200% increase in rough sleepers in 12 months. It should shout "Crisis" at the Taoiseach. The €233 million the Government has cut from the social housing budget since taking up office is not complex. It was a simple decision on the Government's part.
What the Taoiseach needs to resolve today with his colleagues is to tackle this issue and to recognise that one cannot solve a housing or homeless crisis without houses. One cannot end an accommodation crisis without accommodation. This requires the Government to invest. Tea and sympathy will not cut it. Yarns about meeting individuals on the streets, as enlightening as that clearly was for the Taoiseach, will not cut it. When will the Government invest? When will it release funds to local authorities in Dublin and elsewhere to ensure people in bed and breakfast accommodation or hotel rooms or sleeping on the streets will have a place to call home?
Deputy McDonald said to me that I did not understand what was happening on the streets. Name me a predecessor of mine in this position who took time to go down the streets and talk to these people and-----
If the Deputy thinks that it is just a yarn to say that a person tells me where he or she hides a sleeping bag and bits and pieces during the course of the day, if Deputy McDonald believes that this is some kind of smart alec remark, then it is beneath even her to do that, representing the party she represents.
I think that homelessness is not just a feature of housing accommodation. There are a range of things that Deputy McDonald has not referred to at all. The Government is revising a public housing policy for the first time in a number of years. It is a requirement and a focus of the Government to work with NAMA, which has units available to it, on all these sources to make these available.
It is also a function of the city council. Why am I being told by Deputies from my own party that there are houses and units derelict and left vacant in this city for a very long time that could provide good accommodation, not bed and breakfasts-----
-----being delivered to best effect. This is an issue that is not new, unfortunately. It is an issue that has fluctuated over the years, but it is a case of organisations and State agencies and Departments and Government working together in the interests of recognising the scale of the problem and how many houses one needs to provide to people.
Up to 30,000 families face eviction due to the Government's failure to protect them. Mortgage holders will not qualify for the insolvency procedures because they have no disposable incomes or disposable assets. They have fully engaged with their lenders. They are not strategic defaulters. Their only assets are their family homes. They hold modest mortgages, many of less than €100,000 and almost all of less than €200,000. They are all low-income families, many headed by unemployed people.
They are in this position through no fault of their own. They took out mortgages when employed to put roofs over their heads and to provide for their families. Now, they are unemployed because of the reckless activity of the entire Irish establishment, including the Central Bank, the banks, the Government, their cheerleaders in the media and the State research bodies that predicted a soft landing.
The same banks that destroyed society and that we bailed out are threatening these genuine mortgage holders with eviction. I have a letter from one of the pillar banks to such a mortgage holder. It outlines the options available to the person, including voluntary sale and voluntary surrender. In the event of a shortfall, the person would remain liable under all of the options for the outstanding debt, including accrued interest, charges and legal, selling and related costs. The bank would always seek the gross sale proceeds.
The letter threatened eviction. The bank noted that-----
-----forbearance was not appropriate, given the fact that the person's financial position was unsustainable, and that, if the repayments due were not met and arrears accumulated on the mortgage, the matter would, regrettably, be referred to solicitors.
Such conduct from banks that we have bailed out is outrageous, unjust and unfair.
Will the Government legislate urgently to enable these unfortunate and blameless families to stay in their homes or will it continue to allow the banks to deploy the modern equivalent of the battering ram?
The position is that I would say all parties in this House elected by the people do not want to see anybody thrown out of their home. The sad fact is, however, that, in a number of cases, it is going to be very difficult for some people to hold on to their homes - some.
The Government has put in place all of the mechanisms to help every person who is a mortgage holder who has got a problem. There are 47,000 restructured permanently already. The numbers are being assessed by the Central Bank. Despite the fact that the party opposite decried the personal insolvency agency, claiming that banks had a veto and that this would result in thousands of people being evicted, the first evidence of cases going through the personal insolvency agency do not seem to indicate that.
As these cases are worked through, we will have evidence of the actual situation. If those hard-working people who, through no fault of their own, find themselves in this position of having a problem with their mortgage, the first thing they must do is engage with the lender.
-----being implemented by the Central Bank to work out a solution in each and every case. The Governor of the Central Bank has been very clear about the targets set by the Central Bank for banks and lending institutions to work out solutions in each and every case. It is perfectly obvious that the people who are applying for mortgages and who are in a position to purchase houses are not going to get caught in the same trap as those who have gone before them.
Despite much cynicism, the Government has acted responsibly to put in place codes of practice, targets and legislation to help the very people Deputy Healy spoke about. If they took out a mortgage and found that because of unemployment or other changed circumstances they are unable to pay, there is now a solution for every case. It means, however, that in every case those concerned must work out what solution is in their best interests. We do not want to see anybody lose their homes.
While the Taoiseach continues to put his head in the sand and washes his hands like a Pontius Pilate act, many of the people I am talking about will end up on the streets, as Focus Ireland said this morning. It is certain that families evicted from their homes will end up on the huge local authority housing waiting lists. Some 110,000 families are already on those lists and more will join the end of that queue. It is also certain that they will be entitled to rent supplement at a significant cost to the State.
The mortgage to rent scheme would allow these families to stay in their homes on a rental basis and also give them an option of repurchasing in future if their financial circumstances improve. Surely that scheme would be both socially and financially beneficial to families, the State and even to the banks. However, even though we bailed out the banks they are resisting this scheme. The Government seems to have abandoned the scheme. There have only been 60 approvals in that scheme since it was introduced.
Will the Taoiseach personally intervene with the banks to ensure that they fully operate the mortgage to rent scheme? That would give some hope to the 30,000 families involved who are facing eviction. This is a huge problem.
There were 45,177 permanent mortgage restructurings up to the end of September, which is an increase of 3,500 on the August figure. The Minister of State, Deputy Jan O'Sullivan, is working on a number of those smaller, more precise areas, including mortgage to rent and split mortgages. She is following through on that.
There is no point in leaving the matter aside because it will not sort itself out. A deal has to be cut in all these cases. That is why 70,000 mortgages have been restructured and over 45,000 have been permanently restructured. That did not happen of its own accord. It is because of the legislation, the targets, the code of practice and the assistance for people to engage directly with lenders.
The housing supplement is being changed to give a different incentive so that people will have an opportunity to get back to work. The letter that Deputy Healy has is not a solution.
This matter has been discussed with the Central Bank whose Governor has set down targets for every bank to sit down with every mortgage holder and work out a solution in each case. Evidence of the much decried personal insolvency legislation is now becoming clear from the initial cases going through, that the banks do not have a veto. If the banks decide not to deal through the personal insolvency agency, they may get nothing at all if the person follows a bankruptcy route. That has been changed from 12 years to three.