Dáil debates

Thursday, 14 January 2016

Hospital Emergency Departments: Motion (Resumed) [Private Members]


The following motion was moved by Deputy Caoimhghín Ó Caoláin on Thursday, 14 January 2016:

Debate resumed on amendment No. 1:

1:05 pm

Photo of Michael KittMichael Kitt (Galway East, Fianna Fail)
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There is one hour and 45 minutes remaining. Is Deputy Kelleher in possession?

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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No, but I will take possession if the Leas-Cheann Comhairle so wishes. When the Minister came to the House it was quite obvious he bypassed the Department of Health and went straight to the Fine Gael press office. He more or less read a Fine Gael press release into the record of the House. Time and time again health services and emergency department overcrowding have been debated in this House. There has been, unfortunately, very little response from the Government to the ongoing crisis in the Department of Health, in the health services and with the delivery of care. It is happening day in and day out but the Minister comes in and effectively dismisses the legitimate claims of Deputies opposite that health services are under-resourced, with undercapacity, increasing delays in access to outpatient and inpatient services and overcrowding in emergency departments. Many Deputies on all sides of the House say that consistently in this House. The motion has validity in the sense that it raises the genuine concerns and experiences of individuals over a long period of time who have been languishing on trolleys for inordinate periods.

Emergency medicine consultants say on a daily basis that health and the lives of patients are being compromised. An actuarial or statistical analysis would tell us that people are dying because of overcrowding in emergency services and there is a detrimental impact on health outcomes for people who languish for inordinate periods on trolleys.

I found one paragraph in the Fine Gael press release quite fascinating, which the Minister actually failed to read. I do not know if it is in his script but it is in the one presented to me. After some historical lecturing, we have, "In contrast the Government has developed plans recognising the range of difficulties confronting our health services and the reality that it will take a number of years, resources, commitment and long-term thinking to achieve fundamental improvement." That is the kernel of the issue because the Government does not have a plan. The bottom line is that the Minister of Health would not be the Minister if the policies being pursued by this Government were successful. The last Minister for Health was sacked and it was not the Opposition who sacked him but the Taoiseach of this country, because of the ineptitude, the inability to manage the health services and its budget and the inability to put in place proper measures to ensure that the basics of the commitments made by the Government would at least be honoured.

The Minister was also brought in to euthanase universal health insurance with a smile, to let a key, central plank of Government policy fade into the ether. We are not being alarmist in highlighting the lack of any strategy or coherent plan from the Government. By its own admission, the previous Minister, Deputy James Reilly, the deputy leader of Fine Gael, was sacked. It was very evident early on that the model being proposed for universal health insurance, the Dutch single-tier universal access model which was fed into the programme for Government, was going nowhere but the previous Minister could not admit the failure so it was handed to the current Minister to let it fade away gently into a distant memory. Unfortunately, the difficulty is that there is now no plan from the Government. The Minister talks about long-term thinking to achieve fundamental improvements and acknowledges all the things the Government is doing to address the problems, but all those things are addressing the problems it previously created. When he took office in 2014, one of the first briefings the Minister received was on the lack of stepdown and home care packages and the cut in home help hours feeding into the difficulties with delayed discharges and the inability to get people through the hospital system and through the other side with stepdown, community care and nursing home support schemes. It effectively took the scandal of people having to wait for 20 weeks to be approved for fair deal before the Minister acknowledged that this was a problem.

The Government consistently only acknowledges problems when there are crises in certain areas. This month, January, is no different from any other month in recent years in terms of overcrowding in emergency departments. There has been a litany of horrific individual cases with regard to the amount of time people have had to spend on trolleys in emergency departments throughout the country. The Taoiseach has previously expressed shame and anger in the Dáil about what was happening, only to find that it happened again the following day and the day after. This is particularly the case with elderly people. Over Christmas, I was asked by a family to make a telephone call to the HSE and to a hospital. Their 91 year old father who had pneumonia was on a hospital trolley and was facing a second night parked in a corridor in the emergency department. The man was subsequently put into the hospital system, was successfully treated and was later discharged. However, for the first 40 hours he was on a trolley, with the nurses and doctors trying to deliver the best care they could under those circumstances.

The Minister has conducted whistlestop tours of emergency departments; he claims he has done them two or three times. If he continues to do them so frequently, he will meet some of the same patients again. They will still be in the emergency departments as they will be waiting so long. The difficulty is that nothing is happening to address the underlying problems. The Minister has read the policy documents of the Opposition parties, and we thank him for that. We would also appreciate if there was a little more engagement in general and intense debate over the next number of weeks about what we expect from our health services, what we demand of them and how we intend to fund them.

The Minister cannot say he is committed to addressing all of the underlying problems in health while the Taoiseach is travelling around the country saying that the taxation base will be cut to the point where it will be unable to sustain public services in general. There will be a plethora of promises. The Taoiseach is effectively like an auctioneer at this stage. Wherever he sees something he will throw out the best bid possible. In the past number of weeks there have been consistent briefings on the increased intent to buy the electorate through tax cuts. At the same time, the Government will be promising increased numbers of consultants, nurses, teachers, gardaí and better public services. If the Government fulfils that, it will require a taxation base, but it is effectively eroding that base. Commitments to public service require that there is at least an honest debate about how it is intended to fund them. The Government's policy in its tax cut proposals is an American style taxation model where, effectively, it is a case of winner takes all. The more one earns, the less one pays.

We must be honest with ourselves. If we wish to sustain public services, there must be some concept of a commitment to a progressive taxation model that funds them. In all of the Government's budgets since it took office, the Labour Party was there to pretend its purpose was to keep an eye on the Fine Gael Tory policies, but that did not happen. There have been five regressive budgets in which those who are suffering most and in financial hardship are expected to pay proportionately more. Property tax and water charges are arbitrary. There is no ability to pay clause. Pensioners have had the €2.50 prescription charge foisted on them despite another key commitment made by the Government. The problem is that all of the Government's policies were based on focus groups. There was not a person in this country prior to the last election who was not sitting around a table somewhere being paid a few euro to say what commitment they thought a political party should make. The country was focus grouped out of it. The parties in Government had all of that data and information, and then published policies to appease the various sectors of the electorate. The difficulty is that they were not able to follow through on those promises. The universal health insurance model is a key component of that.

One can drill down from the national policies to the policies in local areas. The Government parties promised the maintenance of hospitals, to enhance the services in hospitals and to build new hospitals. A new hospital was to be built in the north east, for example.

1:15 pm

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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Fianna Fáil promised that.

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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All of these commitments were made by Fine Gael-----

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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It was former Deputy Dermot Ahern.

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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-----but nothing has happened. We must accept that our health services are in crisis. There is a deficiency of funding and a lack of capacity. We must increase the number of front-line staff. That will require additional resources and funding.

There are also the other failures in dealing with the problems that manifest themselves in the emergency departments. There are simply not enough community care services in place. The public health nurse system is under significant pressure. There are no community care geriatric services. For example, when people in nursing homes get sick or require medical attention, the nursing homes are often dependent on out-of-hour GP services. It is not good enough in this day and age that out-of-hour GP services are often servicing nursing homes. There must be proper specialist services in geriatrics at community level. What happens, as the Minister sees on his visits to emergency departments, is that elderly frail people are parked on trolleys. They should not be there. They are languishing for an inordinate length of time, which creates greater risks to their health and well-being. The facilities are not available in the community so everything is channelled back into the emergency departments.

The Minister, Deputy Varadkar, and Deputy Twomey, two medical practitioners, are sitting side by side in the Chamber. They should at least acknowledge that our GP services are in crisis. The renegotiation of the GP contract is a critical component in ensuring that chronic illness and disease are dealt with in the GP practices and in the home care and community settings. No efforts have been made to enhance the capacity of our GP services. GPs will tell the Minister in the context of children under six, and he is probably well aware of this, that without enhancing capacity some other group is suffering. GPs are saying openly that their surgeries are overwhelmed with attendances and they cannot give the time required not only to elderly patients, but also to other people with chronic diseases and illnesses. Again, they are being referred back into the acute hospital system.

Many of the policies the Government has pursued in recent years in terms of cutbacks to home care packages, the under-funding of the fair deal nursing home scheme and cuts to home help services - a key decision made by the Government - had a profound impact on people's quality of life and their ability to stay at home with some assistance to help them live as independently as possible. These were policy decisions of the Government. The nastiest one of them all, and one that shows the Government is bankrupt when it comes to basic decency in how it looks after people, was the issue with the discretionary medical card. For over two years the Taoiseach, the Minister for Health and the Minister of State at the Department of Health told us every day that there was no policy change in the area of assessment for discretionary medical cards and the guidelines that underpin it. However, the Minister for Finance, in advance of the local elections in 2014, decided to let the cat out of the bag or the rabbit out of the hat. He said, effectively, that the Government would change the policies but it would wait until after the election as it did not wish it to be seen as an election stunt. There has been dishonesty at the heart of the Government in terms of health care, health funding and the policies underpinning them.

I commend the motion. Sinn Féin has a right to table it. I also have a right to table motions on health and to speak on them on a continual basis. It is not about electioneering, because we have been doing this since the last election, but about holding the Minister and the Government to account. More importantly, it is about ensuring there are clear alternatives in finding pathways to ensure we have health services that provide access to people when they need them and in a timely fashion.

That should be underpinned by proper working conditions for our medical staff who are working under enormous pressure and stress every day in overcrowded, underfunded emergency departments throughout the country. Most of this is the direct result of the Minister's failings and those of his predecessor and the Government's lack of commitment to public health.

1:25 pm

Photo of Seán BarrettSeán Barrett (Dún Laoghaire, Ceann Comhairle)
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I call Deputy Tom Fleming who is sharing time with Deputies Paul Murphy, Thomas Pringle, Clare Daly, Mick Wallace and Joan Collins.

Photo of Tom FlemingTom Fleming (Kerry South, Independent)
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In 2015, the number of public patients waiting nine months or more for surgery increased by 5,600 following the cancellation of thousands of operations due to overcrowding in emergency departments. As overstretched units teemed with people on trolleys, hospitals had to free up beds, which left a growing number of people waiting in the queue who had otherwise planned for admission. Patients from emergency departments who were already enduring long hours on trolleys had to fill many of the beds instead. Overall, 60,000 people are currently on the surgery waiting lists. These include people who have been referred as well as those who have been waiting for longer periods. We are seeing the cumulative impact of increasing workloads and reducing resources on the quality of care and support individual patients receive. This has been taking place over the past decade and is clearly having a detrimental effect on services. Other less profiled but perhaps even more important areas include the lack of community services for people with disabilities and those enduring mental health conditions and chronic conditions. Often, these are among the youngest, oldest and most at risk in society.

The home help service for vulnerable and elderly people is probably the best and most effective means of delivery of care to ensure people can remain living in their communities at a very low cost. This is the environment in which people are happiest. There is a policy of upgrading and developing the delivery of community care in general, but what is happening on the ground is contrary to it. There is certainly a deficiency and we need to rectify it as a matter of urgency. The regressive measures and cutting of home help hours are compounding the problems in an already diminishing service. The service for many elderly and infirm people is cut down to the minimum. The cost of home care provision is significantly lower than the cost of nursing home provision, but there is a current emphasis on forcing those in receipt of the former into private nursing homes as an alternative means of care. I ask that this be addressed immediately and provision made in the current budget for 2016.

Photo of Paul MurphyPaul Murphy (Dublin South West, Socialist Party)
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We all know the Government pitch for its own re-election. We know that the choice we apparently face is between stability and chaos. It must be a slogan that sounds very nice and clever in the minds of the Tory strategists for Fine Gael. The problem the Government has is that out in the real world, in particular our health service, there is no stability. There is instability and chaos. There is chaos in the health service. Last year, almost 100,000 people - 93,000 people - waited on a trolley for an inpatient bed. That is up from 77,000 in 2014. Those people and their families on waiting lists have no stability. More than 500 people are today sitting on trolleys waiting for a bed in an accident and emergency department. For them, there is absolute chaos. It also undermines the claim of the Minister for Health that the numbers on trolleys are going down. What about the 91 year old patient who, in November of last year, spent 29 hours in accident and emergency in Tallaght where, according to a doctor there, he was, in effect, subject to torture? There is no stability for him.

Why is this chaos unfolding in our health service? Is it a natural disaster to which we are all passive bystanders, wringing our hands, saying how bad it is and wishing we could do something about it, but about which none of us can do anything, regardless of whether one is the Minister, Taoiseach or other member of the Government? It is not. It is a man-made disaster. In fact, it is an austerity-made disaster. In 2016, the Government has budgeted to spend approximately €14 billion on both health and children. In 2009, it spent €16 billion on those areas. It is a result of that austerity. The Government will talk about doing more with less. There is only so much more a limited number of staff can do when they are already massively overworked and overstressed. The cuts must be reversed. There is a policy deliberately to push people into private health insurance, undermining the public health service in order to push people into the arms of the profiteers in the private health insurance companies. What we need is an end to and a reversal of the cuts and a national health service with proper, decent health care for all regardless of income.

Photo of Thomas PringleThomas Pringle (Donegal South West, Independent)
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I support the motion fully. Just as the housing crisis was manufactured by the Government and just as the mortgage crisis was manufactured, the crisis in the accident and emergency departments in our hospitals throughout the State is a manufactured one. What is stark in all these crises is that the Minister and his Government are unwilling to do anything about it. Health services have never recovered from the crisis initiated in the 1980s with the "Mac the Knife" cuts when more than 3,000 beds were taken out of our hospitals. By the time 2008 and 2009 came, those beds had not been replaced. The Government has now taken a further 2,500 beds out of hospitals throughout the country through the cuts it has implemented. The EU average is five beds per 1,000 of population. In Germany, the average is eight beds per 1,000 of population. In Ireland, we have 2.5 beds per 1,000 of population. That is the crisis in our health service and the crisis over which the Minister and his colleagues in government have presided. Indeed, Fianna Fáil presided over it in its time.

The only solution to the crisis is investment. The solution is to invest in our health services and build a service that can cater to everyone's needs. We have a growing elderly population. In the next ten years, our population of over 65s will double. We need to be building extra beds, not merely restoring the 5,500 beds which have been taken out in the past 20 years, to cater for the extra demographic demand coming down the line. In its hope of buying the election, the Government is promising all sorts of tax cuts and promising to build proper services nationally. The two are not compatible. The Government is trying to sell the people a pup in trying to sell that proposition. We need investment. To provide that, we must improve and maintain the revenue we have in a booming society. We must build the services which can meet the needs of our population nationally.

Photo of Clare DalyClare Daly (Dublin North, United Left)
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It is a fact that there have been more people on hospital trolleys during the watch of this Government and the so-called days of recovery than under the darkest hours of its predecessor. The counter-motion put forward by the Government today tries, in essence, to blame citizens for getting older and causing the crisis. It is utterly ludicrous. There are people on trolleys because they cannot get beds. It does not take a genius to work that one out. One reason they cannot get beds is that there are not enough of them, but a further critically important factor is that there is nowhere for people to go when their hospital treatment is finished.

There are two reasons for this. First is the essential privatisation of care of the elderly and nursing home provision in the State. It is now big business to be profited from and the care of the elderly is a secondary factor. The other reason is the vicious cut in home help hours and the failure to provide adequate care to allow people to remain in their homes. What is the consequence of that? Every day there are crisis meetings in all of our major hospitals to see who they can get out. It is not dictated by medical needs of patients but by who can be got out to free up beds for people later on. That means staff are under pressure to send people home without adequate care. I know of cases where there was pressure to send home people who were on oxygen without the apparatus being there to administer and support their needs. We all know the situation from our own areas.

We have all received representations from people whose parents have been sent to nursing homes far outside their areas. If they do not have cars, they might not be able to visit. Private nursing homes can dictate what goes. They are there to make money, not to be concerned about the needs of those in their care.

Deputy Joan Collins will not be coming, so Deputy Wallace and I will share the remaining time, if that is okay.

1:35 pm

Photo of Seán BarrettSeán Barrett (Dún Laoghaire, Ceann Comhairle)
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Did you tell your colleagues?

Photo of Clare DalyClare Daly (Dublin North, United Left)
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Photo of Thomas PringleThomas Pringle (Donegal South West, Independent)
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We are happy enough.

Photo of Clare DalyClare Daly (Dublin North, United Left)
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We all got texts. I saw the Ceann Comhairle getting agitated, so I thought I should tell him just in case.

The important point is the Government's assertion that competition will create more places. There has been an increase, but where organisations are running nursing home care to generate a profit, it is a problem. A lady in my area was approaching her 95th birthday and was ready to go to a new state-of-the-art nursing home beside Dublin Airport. It was near to her family and so on. Due to the HSE's inability to strike a deal with the private provider, however, that 90-bed facility is essentially lying idle. It has one full-time resident, which has been the case for almost a year. Former hotels in Finglas that are in the ownership of NAMA have been converted into nursing homes to generate profit for their owners. Articles in the business sections of our newspapers laud the business opportunities presented by nursing home care. Why did NAMA not provide this facility to the HSE so that the latter might run the services directly? With hospital staff holding emergency meetings every day about where to send the people occupying hospital beds, a decision could be made in patient's interests to release them to their families instead of on the basis of the diktats of private gain from nursing home care.

Photo of Mick WallaceMick Wallace (Wexford, Independent)
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Most people agree that there are problems with our health service. Indeed, it would be a surprise if there were none. The Taoiseach came to power with a revolutionary plan for changing the health service. Fine Gael's big idea was for universal health insurance, free general practitioner, GP, care for all, the slashing of hospital waiting lists, the abolition of the HSE and the establishment of hospital trusts. In reality, the health service caters to the interests of those who can afford health care, insurance companies and pharmaceutical companies more than it does to the needs of the general public.

The Government, continuing the work of its predecessor, has implemented a savage programme of resource cuts. Between 2009 and 2015, health spending was cut by 27%. Since 2007, staff numbers have decreased by 10%. At the same time, the population has increased by approximately 8%, the number of people aged over 65 years has increased by 14% and more people than ever have medical cards due to unemployment and lower incomes.

The Government's decisions have worked in direct opposition to the needs of many. Through its implementation of the neoliberal austerity programme, it is pushing inequality to levels not seen in Ireland in our lifetimes. The Think-tank for Action on Social Change, TASC, conducted groundbreaking research last year that showed that Ireland had the highest level of pre-tax income inequality in the OECD, a situation that has led directly to poverty and social inclusion among those whom neoliberalism does not serve.

While the Government's economic policy drove people into becoming more likely to be dependent on the health service, the Government systematically dismantled its capacity to care for them. To cite Dr. Julien Mercille, it is not recessions per sethat "pose the greatest risk to public health, but slashing social safety nets," which can make economic shocks like losing a job or a home turn into a health crisis. The measure of a government is how it treats its poor and those who most need its help, namely, the elderly and minorities. Sadly, one can argue that the Government has taken better care of those who least need its help. This is not the mark of a good government, but it will be this Government's legacy. Inarguably, inequality has increased in the Minister's time in government, which is a damning indictment of the Government's time in office.

I am not stupid. The Minister's job of trying to run the Department of Health is the most difficult in government. Regardless of whether he remains in position over the next five years or someone else becomes Minister, addressing every problem in the health service will be difficult. The HSE is like a monster that is out of control. I wish the Minister well with it, but people want a better health service, and that must happen.

Photo of Seán BarrettSeán Barrett (Dún Laoghaire, Ceann Comhairle)
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Deputies Tom Barry, Regina Doherty, Jerry Buttimer, Catherine Byrne, Paul Connaughton and Liam Twomey have five minutes each. As Deputy Barry is not present, Deputy Regina Doherty will begin.

Photo of Regina DohertyRegina Doherty (Meath East, Fine Gael)
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Undoubtedly, the Fianna Fáil spokesperson can speak eloquently and has a particular turn of phrase, but his criticisms of the current state of affairs and the money that has been removed from health in the four years prior to this one are ironic, given that there was no recognition of the fact that there was no money in the first place because of Fianna Fáil's management while in government over the preceding ten or 14 years. This irony is not lost on anyone else. We have listed health Ministers in Fianna-Fáil-led Governments, including Brian Cowen, Micheál Martin and Mary Harney. After nearly five years in opposition, we still do not have a Fianna Fáil health policy.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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That is true.

Photo of Regina DohertyRegina Doherty (Meath East, Fine Gael)
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These facts speak for themselves. Fianna Fáil had nothing to discuss at the launch of its advertising campaign yesterday but Fine Gael.

Instead of taking the opportunity of this motion to debate the virtue of the health policy that it announced a couple of weeks ago, Sinn Féin has discussed the suffering of patients and families purely for the purpose of political point scoring and making itself look good. Nor has it explained where it will get the extra €3 billion that would be needed to fund the new and improved health service that it claims it will deliver. All it has said is that the €3 billion will come from the rich. Seeing as how it believes people are rich when they earn €30,000, everyone in the country will pay for that extra €3 billion.

To claim that we do not have a plan is not true, but to say that the health service faces challenges is. It always has done and always will. One reason for this has been the increasing number of people presenting at emergency departments year on year in recent times. People are living longer and getting sicker. Coupled with this is the removal of resources and services from the system because of the economic climate of the past five years. Thankfully, however, the situation is starting to change. The increased funding over 2015 has allowed us to implement 88 steps in a programme that arose from last year's analysis by the Minister, the emergency task force and other elements of the health services. One of the key changes made in the past six to 12 months is the extra funding for the fair deal scheme. We recognised that a waiting time of more than 20 weeks for a bed in a nursing home was not acceptable. The necessary extra money was sought and acquired by the Minister and there is now a waiting period of less than three weeks to move people from acute hospital beds to where they should be and where they can get more appropriate care - that is, nursing home beds.

Of more importance is the need to reopen the beds that were closed in the 1980s and recent years. This process was started last year when the Minister opened more than 300 step-down beds around the country, which was welcome. There is a commitment to introduce a further 127 step-down beds in the first quarter of this year.

Recruiting nurses poses an issue, but one would have to be blind not to recognise that the HSE and individual hospital groups are doing everything they can to encourage nurses who are working outside the country, including those who left Ireland in recent years, to return to our health service.

We will start to see that bear fruit.

There has been a noteworthy increase in the number of people presenting in emergency departments with respiratory problems and flu-like symptoms. Some of the key initiatives to address this include the rolling out of the winter resilience plans. Those concerned are working alongside the community and primary care service providers. The initiative will work, and its purpose is to prevent unnecessary admissions to hospital.

The simple response to the emergency department problem is that it is up to the departments to solve it. It clearly is not; it is up to the entire service to solve the problems. The answer must involve the acute systems and the emergency departments themselves, but also general practitioners, primary care services, home care services and public health nurses. We must ensure there are organisations to keep people well at home and provide the relevant services.

We must bear in mind the increase in funding for home care packages and public health services, in addition to the provision of general practitioner access cards to children under six and those over 70. All these initiatives are working. The improvements with regard to delivery teams in our primary care services are very welcome. While there are challenges, they are absolutely being addressed. We will continue to address them.

1:45 pm

Photo of Jerry ButtimerJerry Buttimer (Cork South Central, Fine Gael)
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I welcome the opportunity to speak on this motion and thank Deputy Ó Caoláin for tabling it. This motion should not be used as a political football. It is about the people, including the people Deputy Crowe spoke about this morning and hospital patients such as my father, and it also concerns the staff who work in hospitals. Those who use the word "crisis" should think about what they are actually saying and what they are doing about the health service. The health service is not just about our emergency departments or acute hospitals.

It behoves all of us at the beginning to congratulate and pay tribute to the men and women who work at the front line in primary care and hospital settings. There is no magic wand that can bring about gargantuan change of the kind some Members on the benches opposite speak about. To be fair to Deputy Ó Caoláin, he never said there was, unlike others in his party.

We are talking about having health services that are demand led and about people and how we treat and care for people. If it were a matter of investment alone, there would have been no problems in the time of the boom. We would have had hospitals in every corner and there would have been no need for any realignment of services. There would have been no need to worry about anything, but we just proved that is not the case. This morning, the Minister highlighted the "fantastic" legacy of Sinn Féin’s Minister in the north of our country. That just proves that Sinn Féin did not have the answers in the north of our country either.

Let us, therefore, examine the context to our objective. If any of us is ill or has a family member who is ill, our first port of call is the emergency department. It should not be. Primary care is critical to how we change the delivery of health services to all citizens. This requires collective and national buy-in. Deputy Mary Lou McDonald, Deputy Regina Doherty and I were members of the Constitutional Convention. Although the State is spending over €13 billion per annum on the health service, there are still issues affecting it, about which we are speaking in the Chamber today. Is it not time we stood back and had a Constitutional Convention-type approach to having a better model of delivery?

I work with Deputy Ó Caoláin on the health committee. He has produced his document, and the Minister has his document. I am sure Deputy Billy Kelleher will have some type of document also, although the Minister is correct in stating Fianna Fáil ran from the health service for ten years and left poor Mary Harney languishing there. I would not hold my breath in Fianna Fáil’s case. Why do we not have a national conversation, involving us all, in regard to how we change our health system? That demands that some with vested interests change their mindset regarding the health area.

Undoubtedly, we have policy initiatives and there has been an increase in funding. The Minister spoke this morning about the four-pronged approach. I agree with him completely that it is a question of capacity, moving people out of hospital into different settings, ensuring there is funding, and changes to work practices. All of this is happening.

Reference was made to recruitment. In the city of Cork, which I represent, Mr. Michael O’Flynn and his advocacy group have a proposal in regard to a new hospital. This is important because it is about the creation, in this case, of an elective hospital that would take the pressure off Cork University Hospital to ensure better delivery of health services.

It is important that community services operate in tandem with acute services. In Cork, there is a very strong community service and community intervention. The initiatives have worked. I commend the staff working in Cork because it is a question of ensuring people have access to health services in a timely and dignified manner.

Photo of Catherine ByrneCatherine Byrne (Dublin South Central, Fine Gael)
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Today's motion is about a serious issue of which we are all acutely aware. Words are cheap but it is fair to say our health service is in difficulty. However, this Government is working hard to address the problems that exist in our hospitals. We all want a better service. No one wants to see patients, particularly the elderly, on trollies, and no one wants staff working under huge pressure, as at present.

For 2016, the health service will have funding of €13 billionfor current expenditure. This represents a €900 million increase over the funding for 2015. However, it is not a question of achieving a quick fix with funding alone, and one size does not fit all. The emergency department task force is committed to tackling the overcrowding problem, and hospitals have plans in place to deal with the additional challenges that appear during the winter months. By comparison with last year, the number of patients on trollies has decreased. However, this time of year results in ever-growing concerns about emergency departments, which are stretched to their limit. There is an increase in the number falling ill, especially with respiratory problems and also influenza and other symptoms. This is particularly the case among the elderly and children. The winter vomiting bug is a virus that has hit homes strongly, and some end up having to go to hospital for a short stay as a consequence. This has put considerable pressure on hospitals, particularly on beds.

During 2015, additional funding of €117 million was provided to the HSE to relieve emergency department overcrowding pressures. There is a renewed focus on interventions in community and primary care to try, where possible, to prevent unnecessary visits to emergency departments.

The Minister recognises the need for more beds at this time of year, and funding of €18 million has been made available to support the opening of new ones. Beds that have been closed are to be reopened.

Other issues concern staff and the shortage of nurses and doctors with specialist training. Unfortunately for the HSE, it has been difficult to recruit staff, particularly nurses and doctors, because some have already entered the private health service and are reluctant to come out of it. We need to attract health care professionals to work in our health service by providing acceptable working conditions where staff are not overwhelmed. Their being overwhelmed can undermine patient safety.

It is important to acknowledge that one of the most vulnerable groups at this time of year comprises the elderly, particularly those with respiratory problems, who always need to be hospitalised, unfortunately. Owing to the increased number of people at work, it is harder to mind older and sicker people at home. It is not the fault of the families concerned.

It is Government policy to support older people in their own homes and communities for as long as possible. As others have said, this is the key to providing a service in a community where people can be looked after by health care providers and served well.

2 o’clock

I commend home helps who provide an important service that needs to be further supported and strengthened in the community. Without the many people who call daily to the homes of elderly people and others to provide assistance, the health service would experience even greater difficulty.

Home care packages are another vital resource to support older people in their homes. More than 1,200 additional home care packages were provided by the end of 2015. Many of my constituents and, I am sure, those of other Deputies, have seen how home care packages improve people's lives by enabling them to remain at home. Family members also have time to spend with their loved ones and do not constantly have to visit them in hospital.

The fair deal scheme is working well and the waiting time for processing applications has declined significantly from 11 to four weeks. However, the waiting time to access beds in nursing homes is a problem in some areas. I speak specifically of Cherry Orchard Hospital in my constituency where there is significant demand for more beds and the new Hollybrook nursing home in Inchicore. Staff in these facilities do wonderful work. I commend, in particular, the staff of Cherry Orchard Hospital. People do not always appreciate the effort being made to provide services for older people.

Primary care is the key to reducing pressure on hospitals. I fully support the extension of local services, for example, out-of-hours and X-ray services and minor surgery.

I commend Sinn Féin, especially Deputy Caoimhghín Ó Caoláin, on tabling the motion, although I will not support it. The Government is on the right track.

1:55 pm

Photo of Paul ConnaughtonPaul Connaughton (Galway East, Fine Gael)
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I am grateful for the opportunity to speak on the motion. I agree with Deputy Buttimer that it is easy to claim the health service is in crisis. While it is generally accepted that there are problems in emergency departments, it is a little over the top to argue that every part of the health service is in crisis. Given that many parts of the health services, including all hospitals, are working well, it is unfair to hospital staff and general practitioners to describe the entire health service as a disgrace. Staff become disheartened when this type of language is used.

There is a problem in emergency departments. The issue of investment is repeatedly raised in this regard, although greater investment is not the only solution. It would be remiss of me not to mention Galway University Hospital's emergency department because, as the Taoiseach has admitted, it is not fit for purpose. Investment in the hospital's emergency department should be prioritised, especially as the hospital is probably the largest in the west. The Minister has visited the hospital on a number of occasions. It is unacceptable to witness carnage every time one enters the emergency department. The hospital desperately needs a new facility. While I am aware that plans for a new emergency department are in place, action should be taken to accelerate the process.

Deputy Buttimer also pointed out that people tend to end up in accident and emergency departments, regardless of the problem they are experiencing. For example, a constituent of mine contacted me some weeks ago about a problem he was experiencing with this teeth. While his case is not an emergency, he is in severe pain. Two weeks ago, he received a text message from Galway University Hospital informing him he was about to be given an appointment. An hour later, he received another text message informing him that the appointment was not for him and a mistake had been made. After months waiting for an appointment, he had his hopes raised and subsequently dashed. When he telephoned the hospital to seek an explanation, it was explained to him that a genuine mistake had occurred. He asked whether he would be seen more quickly if he presented at the emergency department. The person to whom he spoke agreed that it would be quicker to do this but the hospital would not advocate such a course of action. What business does this person have in the emergency department? He did not present at the emergency department because he would still have to wait for eight or nine hours to be seen. This type of case is much too common and means people with minor and major problems end up in the emergency department, many unnecessarily.

Deputy Catherine Byrne raised the issue of primary care services. I do not understand the reason the primary care system operates differently in different areas. It may be the result of a lack of leadership or management in the Health Service Executive. Some hospitals have systems that work well but have not been extended to other areas. This causes much frustration among patients. This phenomenon does not occur in Britain or other parts of Europe. A case in point is an arrangement in place in St. Luke's Hospital, Kilkenny, which I learned about on a visit to the hospital. In Kilkenny, when people cannot be cared for in general practice, they are referred to the emergency department in St. Luke's Hospital. This process commences at this point and hospital staff know the patient will soon attend the emergency department. This practice has not been rolled out to other areas.

The Minister has indicated that he would like to remain as Minister for Health if Fine Gael were to form the next Government, provided more funding was provided for the health service and he had the power to make more decisions. The issue is not simply one of finance but one of management across the board. It is too easy to blame one area for all problems. As Deputy Buttimer stated, we need to have a conversation and someone will have to make difficult decisions. We have not had such a conversation for years. Instead, we hear two slogans, namely, that the health service is in crisis and that more money is needed. More money will not solve the problem. A similar issue arises with regard to the flooding crisis, which is also topical, in that the number of people in emergency departments will decline as the year proceeds but we will end up discussing this problem again at some future point. We must ensure the political focus remains on working towards the solutions that are required. People are frustrated because everyone seems to have the solution but no one is able to pinpoint how to achieve the right outcome. Until we do this, we will not have any success in this area.

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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We should view the health service in the same way that doctors view it, in other words, through the lens of acute and chronic issues. The former include the issues Deputies have raised today, such as the way in which emergency departments operate and the need to have people seen and treated quickly in emergency departments. Deputies like to use the figures provided by trolley watch because they are comparative, simple and may be used to have a go at the Government. There are 344 people on trolleys today, which is less than were on trolleys on this day five years ago. People waiting on trolleys will be an annual problem for the foreseeable future because it is caused by the way in which the health service is organised, as the Deputies opposite are well aware.

It is great that funding for the health service increased this year, following a series of cuts in budgets in recent years. It is not beyond the comprehension of Opposition Deputies that these cuts were necessary given the economic crisis the country experienced, including the significant decline in Government income during the recession. As someone who has been intimately involved in the health service for more than 30 years, I can attest that the cutbacks of the past five years could have been much worse. Health service staff acted commendably in exercising their responsibilities and ensuring that access to services for the acutely ill was maintained throughout the crisis. It does not suit the Deputies opposite to hear this sort of thing but staff in acute hospital services, including accident and emergency services, and primary care rose to the challenge.

Reading through Sinn Féin's health policy document, I note that the party fails to understand what problems the health service will experience in the years ahead. These include obesity, diabetes, high blood pressure, high cholesterol and low levels of activity among large sections of society. The first five pages of Sinn Féin's policy document feature only three lines on the future crises in the health service. If we do not tackle the issues to which I referred, the health service will need more than an additional €1 billion per annum just to stand still. The population is not only getting older but is also less healthy than it should be because of the problems I have identified.

I have been a doctor for 20 years. When I started in medicine, I did not expect to diagnose men in their 40s with diabetes, nor did I ever consider that I would have to check the fasting glucose of a 40 year old. I would have expected to make such a diagnosis or carry out such a check on people in their 60s or older. Nowadays, people in their 40s are being diagnosed with diabetes, with all the complications the condition entails.

These include blindness, heart disease and amputations because of peripheral vascular disease. These problems correspond to vast costs and a major burden on health services now and in future. We may believe that hundreds of people on trolleys throughout the country is a national crisis, but I envisage an obesity crisis and all the problems that it brings. The numbers run into the hundreds in my small corner of County Wexford. If we expand that to the rest of the country, it runs to hundreds of thousands and a crisis, an epidemic, waiting to explode in our health services. By the time I retire, that figure will be in the millions. We are not having the appropriate discussions in this House on that problem. We are going for the short-term political hit instead. Opposition Members have taken the view that they will try to hammer the Government on 300 or 400 people on trolleys overnight when there is a crisis coming down the road towards us.

I was listening to the Fianna Fáil health spokesperson earlier. He was completely oblivious to the fact there might be any problems in the health service in the coming decade. That is not surprising because in the 15 years those in Fianna Fáil were in power they made no policy changes whatsoever to allow for this crisis coming down the road.

We should give the Minister, Deputy Varadkar, credit. He is not only changing policy in the Department of Health, he is doing something more. He is funding the change to policies to allow this to happen. We are funding diabetic care management programmes and asthma programmes in primary care. We are genuinely making an attempt to deal with this for what it is, that is to say, a crisis that is about to explode. There is a need for everyone in the House to recognise this, especially those in Sinn Féin, if they see themselves as a serious all-Ireland party. However, one must read up to page 42 of the Sinn Féin health policy document before there is any mention of what this crisis is going to be like, where obesity is going and what that party is going to do about it. It is unbelievable how much this epidemic is going to cost in our health services. Moreover, it is going to happen within the next 15 years if we do not plan for it now. That should be something that we all talk about in the House. It is something we should take more seriously, rather than the cheap political point scoring that has very much been a part of this debate. I would prefer a more consensus-based approach to the future health care of the people.

I am leaving politics as soon as the next election is called. I will have been 14 years in this House and 30 years as a doctor. Unfortunately, I have seen the quality of the debate about where our future health service is going and it has not changed much in this Chamber. It needs to change radically.

We are lucky. The Minister, Deputy Varadkar, is getting the policy changes and the approach we need to address the problems in a way that is going to make a major change to the lives of the people. None of the Deputies opposite have to deal with - at least I hope they do not, either personally or with their families - the complications and consequences of the unhealthy lifestyles that so many of our population are living with at the moment. It is absolutely debilitating for the individuals and their families. It is coming on at such a young age. There are people in their 50s who cannot walk the length of themselves because of the complications of blood pressure, diabetes, obesity and all the other chronic illnesses that we are simply not taking seriously. We are condemning people to be almost imprisoned in their own bodies because of the complications associated with these diseases. The only solution really is to have a broader approach. We need to see that as the national crisis. This is the crisis we should be taking seriously in this House.

I remember having these debates in this House ten years ago when I was a health spokesperson. We saw it as something that was coming, but it is here now and it is getting worse. That is where the approach to these debates should focus. I hope that when the election is over and the heat is gone out of these debates, we can come to the House and give full support to the Minister, Deputy Varadkar, and the people in the Department of Health to allow them to implement the policies and get the resources to make the necessary changes.

Not all the issues that are problematic in health relate to resources. There are still incredibly restrictive practices within the health services and in the way the health services operate. They cost money and waste resources and are detrimental to people's health care. I offer one example. A good friend of mine was admitted to a major hospital in this country two weeks before Christmas. She was admitted for an orthopaedic problem. During the course of her stay in hospital, she encountered respiratory, cardiac and renal complications, yet she still remains under the care of orthopaedics. I have the utmost respect for orthopaedic surgeons, but they are not good at dealing with acute chronic medical problems. However, because of the way our hospitals are structured, this woman remains under the care of orthopaedics. She should have been moved to a medical ward and put under the care of a medical consultant. The structures in our hospitals do not allow that to happen. If a patient comes in under medical, he stays in medical; if he comes in under surgical, he stays under surgical; and if he comes in under orthopaedics, he stays in orthopaedics. There are too many barriers. That example may be simple for everyone in the House to understand but such barriers go right through our hospitals. There are numerous hidden Chinese walls that restrict the type of care that is necessary. The accusation has been made by many people that sometimes we have a health care system that is organised for those who work within it rather than those who use it. Perhaps it is a difficult conversation and perhaps not one that too many people in opposition are keen to hold before the general election, but I hope it is a conversation they will be prepared have after the general election.

2:05 pm

Photo of Seán BarrettSeán Barrett (Dún Laoghaire, Ceann Comhairle)
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The next group of speakers includes Deputies Pádraig Mac Lochlainn, Brian Stanley, Sandra McLellan and Michael Colreavy.

Photo of Pádraig Mac LochlainnPádraig Mac Lochlainn (Donegal North East, Sinn Fein)
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I have listened to Deputy Twomey and other Government colleagues for the past while. I know that Deputy Twomey is a general practitioner and has experience of the primary care system. I share his concerns. We watched the documentary about sugar, about the increase in diabetes and about lifestyle. These issues have been on the table for many years. The only difficulty I have is that one would think the Government Deputies had just taken up office for a couple months and were asking us to give them a chance to see what they could do. However, they have been in power for five years.

What we have had is a case of chronic underinvestment in the health services. The chief executive of the HSE told a Sunday newspaper that the whole thing is up in the air. The Minister, Deputy Varadkar, knows that the issues are about chronic underinvestment. Let us discuss Letterkenny General Hospital, which has been linked to University Hospital Galway as part of the Saolta hospital group. It is simply not working. I was speaking on radio in Galway some days ago about some of the numbers relating to University Hospital Galway. The Minister will be aware that there are patients right along the west coast up to the top of Donegal who are being referred to the hospital in Galway. The inpatient and outpatient waiting lists in that hospital amount to 40,000. The inpatient and outpatient numbers waiting for more one year come to 5,000. Despite this, patients are being referred there from as far away as north Donegal. It is utterly stupid. Clearly, the necessary investment has not been put into the hospital.

Let us consider the hospital in Letterkenny which is serving a population of 160,000 in Donegal. There are 15,500 on the waiting list for that hospital, including 1,500 who have been waiting over a year. Now, because the Government has not invested in the public hospital there, the HSE must refer people to private hospitals on both sides of the Border. This does not make economic sense. Since the Government has not recruited enough consultants and doctors, it has to hire locums and, in some cases, pay them two, three or four times more than it should be paying them. What the Government is doing does not make economic sense.

I have spoken to senior people in the hospital in Letterkenny. It has been my hospital for many years. The only way I can describe their opinion is to say that they are in despair over what is happening to our hospital. It is our people's hospital. It is where our children are born and where our loved ones die. It is an integral part of our life, as it is in every other hospital in every community throughout the State. We have seen what has happened there. The number of inpatients going through Letterkenny amounts to more than 20,000 per annum. Despite this, we have had the lowest allocation of budget and staff of any hospital in the State.

We have now been linked into the Saolta hospital group. At the start, the people to whom I spoke in the hospital entered into the process with an open mind. They thought things could not get much worse. As I said to the Minister, a year or two on they are in despair. It might do the Minister no harm to meet the clinical directors and senior consultants in some hospitals, have a cup of coffee with them and ask them to speak to him off the record about what is happening. His eyes would be opened.

My local hospital is Letterkenny General Hospital. There are two permanent surgeons to cater for a population of 60,000. To run a 24-hour accident and emergency department in a hospital, a full coterie of consultants and specialties are needed to meet demand. There are locums, who are linked to two permanent surgeons. The Minister will recall that the consultant urologist, Mr. Kevin Moran, had to resign in despair in the early part of 2015 due to the lack of resources available to him.

As the Minister knows, urology is at the heart of cancer care services. Only weeks later, a breast cancer surgeon, who also, like Mr. Moran, carries out other surgeries throughout the hospital, spoke on a local radio station and said he was on the verge of doing the same as Mr. Moran. It was a crisis. The Minister facilitated a meeting in Dublin. It was a good meeting thanks to the fact the consultant, Mr. Michael Sugrue, attended the meeting, told everybody in the room to cut their nonsense and described the reality of the situation and what was needed. We put in place a number of solutions. Some seven months later, they have not been implemented. The Saolta hospital group is all over the place.

As I said, the issue is chronic underinvestment and a lack of doctors, medical staff, budgets, beds and capital. The same applies to the community hospital and primary care infrastructure in communities. All that has a knock-on effect. The Minister knows why we have an accident and emergency crisis. Sinn Féin worked hard over a long period to consult all sorts of experts to come to the Minister with the constructive proposal we have put to him. It is about investment because there is no other way around the issue.

The solution involves examining the fiscal space of €8.6 billion over the next five years. We would allocate €3.3 billion and recruit an extra 6,600 front-line staff because that is what is required. We would move the health service, on an incremental basis over a period of five years,from a two-tier system that is clearly unjust and in crisis to one that is universal. We have outlined our plan to the Minister and, more importantly, to the people.

The people will soon decide on their Government for the next five years and whether it comprises those on this side or the other side of the House. I am interested in the comments of the Minister. He said if he took on the role of Minister for Health again and the people decided that was the way to go, he would like to have the budget and, what is interesting, the authority to do what needs to be done. Frankly, that is a load of nonsense. The Minister clearly has the authority, but the Government has not invested and put in place the resources required. Instead, we have heard the same nonsense today as we heard before about structural issues, staffing issues and things needing to be sorted out. The problems are always blamed on the system or the HSE when the core issue staring us in the face involves resources. We have given the Minister and the people a plan and that, and nothing else, is what will be required to turn this ship around.

2:15 pm

Photo of Brian StanleyBrian Stanley (Laois-Offaly, Sinn Fein)
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I welcome the opportunity to speak on this motion. I heard Deputy Buttimer state that we spend just over €13 billion on health per year. That is wrong. That figure refers to the amount spent on health from the tax take. The Deputy did not include the money that is paid in private health insurance and out-of-pocket expenses to pharmacists, consultants and a range of other services. Several billion euro more is spent on health. The Minister and Deputy Twomey will know, as doctors, that a large amount of money is paid in out-of-pocket expenses, apart from what is allocated from the general tax take. When all the money is added up, one will find we have the second most expensive health system in the world, second only to America.

Deputy Twomey referred to obesity. I saw the television programme featuring Dr. Eva Orsmond on Monday. I got somebody to record it in order that I could watch it. The programme shocked me. I thought I was doing well, but it was an eye-opener in terms of sugar intake. Those returned to Government might look for clearer labelling of food. Even with my glasses on, often I cannot read the labels on supermarket shelves when doing the weekly shopping. Labels on food are not clear in terms of how much sugar and additives are in the different processed foods we buy, something which needs to be addressed.

Sinn Féin is putting forward a comprehensive health policy. We know there is no magic wand and it will take time to deal with the situation. It will bring to Government terms to bring us towards a universal public health system. Nothing short of that is what is needed. It is a way of solving the crisis.

There is major concern locally regarding the Midlands Regional Hospital, Portlaoise ever since the leaked departmental report in 2014 which recommended that 24-hour accident and emergency cover be reduced and the number of beds limited to 20. That would be a major blow to a hospital where 38,000 people go through the emergency department. It is the second busiest such department outside of Dublin. As I pointed out when the report was leaked, rather than reduce the level of services, extra resources are needed. We need full-time permanent consultants to be appointed to the emergency department. Where will patients go if the hours are reduced or the department is closed? Tullamore and Naas do not have the capacity. Tallaght hospital is chock-a-block. I spoke to Deputy Crowe about it before I stood up to speak. There is nowhere to send patients.

At the time the report was met with significant opposition and a further report, which was to be commissioned under Dr. Susan O'Reilly, was to be issued in September, but so far we have not seen sight nor sound of it. We have now been told that will not go to the Minister but has gone on a detour and has been taken to an official in the Department or HSE. The Minister might update us on the status of the report. Has it been delayed in case it causes political difficulties for Fine Gael and the Labour Party in the run-in to the general election?

The Minister has been less than reassuring. I raised this issue in June, at which time he praised the hospital emergency department and staff for their efficiency and assured us there was no question of it being closed. However, he stood over doubts raised within the Department as to whether 24-hour services could continue in the hospital. I hope the decision is not being held back because of potential negative electoral consequences for the Labour Party and Fine Gael.

When I asked whether it was intended to employ a number of consultants and to continue the 24-hour service, the Minister was vague. Despite referring to the large numbers passing through the emergency department, he said any decision would take account of existing patient flows. There is major concern locally about this issue.

There are two doctors on the other side of the House. Some 43 GPs sent a letter to me and other public representatives yesterday. They have said they are disappointed that the draft action plan which was due to be published, that is, Dr. Susan O'Reilly's report and plan following consultations in September, has not yet been published. They are concerned that the delay is due to a political agenda. They said they are very concerned about the situation, which is similar to Roscommon, and that in the aftermath of the general election the same situation will arise in Portlaoise.

They went on to say that they are aware that the future of the 24-hour emergency department remains at risk and that future services may include a 24-hour paediatric assessment unit and a 24-hour acute medical assessment unit. They said they do not believe that such departments can be run safely in the absence of a properly resourced 24-hour emergency department, that such a model is risky, unsafe and potentially dangerous, and that they cannot support it.

They said any reduction in the opening hours of the emergency department would add significant pressures to the GPs trying to practice in the area and the already burdened MIDoc out of hours service. GP posts in Laois cannot be filled and there is a shortage of GPs. The GPs state it cannot be pushed back on them because they do not have the resources and there are not enough of them. I have outlined why patients cannot be sent to Tullamore or Naas, because they do not have the capacity. I am not having a pop. I am just outlining what the staff in the hospitals tell me and others and what the GPs say. These people are in the same position as Deputy Twomey, who is also a GP. They state closing the emergency department at Portlaoise will only ensure unsafe services and they will not support it. They believe the only viable solution to ensuring safe services is the retention and appropriate resourcing of a 24-hour emergency department. This was signed by 43 GPs in the county.

There is huge concern beyond the county. There is concern in south Kildare, Offaly and North Tipperary. The mothers of the on average 2,000 babies who are born there every year come from these areas. I appeal to the Minister in the short time that is left-----

2:25 pm

Photo of Seán BarrettSeán Barrett (Dún Laoghaire, Ceann Comhairle)
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That is ten seconds.

Photo of Brian StanleyBrian Stanley (Laois-Offaly, Sinn Fein)
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The Minister needs to publish the report. It has been sent off to some official. The report on Abbeyleix and Shaen was sent to an official three years ago. It was to be announced after August 2012 and reported on within a couple of months. I have tried to get an answer on this from the previous Minister for Health, Deputy Reilly, and the current Minister but we have not been able to get an answer three and a half years later. Will the Minister publish the report on Portlaoise and set out a clear plan? This is a busy regional hospital. It must be resourced. There is no other show in town. There is nowhere else for these patients to go. They cannot be pushed back on the GPs and they cannot be sent to Tullamore. They must be treated in Portlaoise. This is the simple situation we face. Publish the plan, resource the hospital and let us get on with developing this busy regional hospital.

Photo of Sandra McLellanSandra McLellan (Cork East, Sinn Fein)
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Regrettably, I feel this is a topic that does not need much by the way of an introduction. The crisis in our health system appears to have reached new levels. Unfortunately, on one of the last days of the Government's term, we have had to bring forward this Private Members' motion due to its response, or lack thereof, and the reneging on promises put forward as part of the Government parties' election manifestos last time round.

We all know the pressing issues and strain our health service is under at present, and the media have played an integral and helpful role in highlighting these issues. The number of people on trollies in our hospitals on a daily basis is indicative of a mismanaged system. This is a system that, under the watch of the Government, appears to have gone downhill. Waiting times for appointments have also seen a spike under the current Government. People who require certain special treatments are left in limbo due to long waits. Their conditions are not considered to be serious when looked at relatively. I know of many people who have been on waiting lists for up to four years for hip or knee replacements. I also know of people who have been confined to wheelchairs because they are in so much pain they are unable to get about. Some people are in so much pain that they or family members go to credit unions to take out loans they can ill afford and can hardly pay back to have operations done privately. This is an absolute disgrace. The health services will be unable to cope with the undue stress potentially caused by putting these patients on the long finger.

We require an additional €15 million for the ambulance service. Waiting times for ambulances is an issue that must be addressed immediately. We have seen toomany consequences and fatalities of people who may have been saved were response times at recommended levels. This brings me to the nurses who work in these pressure cooker-type situations and conditions. The media have kept us up to date with the current displeasure of those working in our hospitals in recent times. This unrest has, however, been rumbling in the background for much longer than this. Nurses are stretched in every which way possible. Their main focus is the health and well being of the patients they look after. This time is very limited, due to a significant amount of paperwork and other box-ticking exercises that are required, rather than being allowed to focus wholeheartedly on the patients who most need their attention. They work long hours for little thanks, so with all of this taken into consideration is it any wonder that a discourse developed and proposed strike action was tabled? These are the people who keep the clock ticking and the wheels moving, yet they are treated like spare parts.

Sinn Féin has called for the recruitment of 6,600 additional front-line health workers, including nurses, midwives and consultants. With regard to my portfolio, children face the same issues as adults. Mental health in particular is an area which needs significant increases in funding if we are to protect the health and well being of our generations to come. It must be recognised that we have an aging population and this is why we require more funding for the fair deal scheme which would allow hospital beds to be freed up by increasing the number of nursing home beds. This would require an additional €125 million to increase the amount of nursing home beds by 2,400 over a five year period.

As referred to in my introduction, it seems the trolley crisis will reach a point of no return if left in the hands of the Government. The Government came in with the intention of ending this fiasco, or at least it said it did. Its members state it is down to mitigating factors beyond their control, but it seems a loss of control as opposed to having their backs against the wall. Threatening the closures of accident and emergency departments is a knock-on effect of this lack of beds. It should be addressed in a proactive manner so that a lack of space in accident and emergency departments does not mean hospitals such as Beaumont have to turn people away due to them not being enough of an emergency.

Sinn Féin has been calling for the putting in place of a health care system free at the point of delivery, protecting all the citizens of Ireland. We would like to see an increase of €3.3 billion in spending on health care to move from a failing two tier health system to universal health care. This is all within our alternative budget proposals. We call for a health care system that is adequately funded and a rejigging of the management structures to allow more of the funding to reach ground level. There is no quick fix to our health system, but our proposals would certainly move us in the right direction.

We hope this motion can gain the support of other parties and Independents. This would demonstrate solidarity and a will to fix this problem in a proactive manner. It is all well and good that the economy may be on the rise, but this is not being felt in working and middle class areas. When the Government proclaims the rise in the economy it is meaningless to 90 year olds on trolleys in accident and emergency departments.

Obesity will be a huge problem. I also watched the programme on Monday night. The situation was a shock to the system and much worse than what I and people to whom I have spoken thought. It will be a huge issue which we need to address. I agree with my colleague, Deputy Stanley, that it is almost impossible to read labels. The incoming Government, at the very least, must ensure all sugar is labelled correctly and that we can read the labels. According to the documentary, there are approximately 78 different words or terms which mean sugar and most people are not aware of this. We need to address it.

Photo of Michael ColreavyMichael Colreavy (Sligo-North Leitrim, Sinn Fein)
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One of the hallmarks of a decent republic is that the people can access quality health care when they need it, irrespective of age, geographical location or ability to pay. Unfortunately, we do not live in such a republic. It can be informative to look at the OECD 2014 health at a glance report for 2014. Many people do not know that Ireland is below the EU average number of doctors per 1,000 people. We have 2.7 compared to the EU average of 3.4. The number of hospital beds per 1,000 people is also below the EU average. We have four compared to the average of 5.2. However, the notion is out there that somehow we have plenty of resources but they are being badly used.

There were 12,683 beds in the system in 2013. As far back as 2006, hospitals were operating at close to 100% capacity and a recent OECD report confirms that is still the case. There is no other word for this but "dangerous". The accepted and researched wisdom is that any hospital with a greater than 85% average occupancy increases the risk of harm for patients, including the risk of hospital-acquired infections. It is easy to say the resources are there but are not being used. The real problem is that the necessary frameworks and infrastructure are not in place. There have been repeated cuts to the service and when that happens, it is no wonder there is bleeding.

The main issue with emergency departments in acute hospitals is that there have been continual cutbacks to budget, staff numbers and bed numbers. In addition, lack of access to beds in community nursing homes creates a delay in getting people out of hospitals. Another factor is the bureaucracy, red tape and delay involved in accessing home care packages under the home support scheme. It makes no economic sense or health care sense to keep people who could and should be looked after at home in acute hospitals simply because administration has to work its magic before a home care package can be organised. Part of the problem is what is referred to as bunker management. We have a bunker called acute hospital services and a bunker called primary and continuing care services. Occasionally a head will pop up over the bunker but more usually, and particularly following a succession of cutbacks, each bunker will jealously guard what it regards as its budget.

There is nobody standing between the two bunkers or seeking to demolish the bunkers and demanding that the money follow the patient and that what is right for the patient must be done. If continuing care service is more appropriate for a particular patient in a particular set of circumstances, that is where the patient should go and he or she should go there now. We should not have two or three weeks of form filling and a series of approvals, leading to interminable delays. While that is happening, people are lying on trolleys in emergency departments or having to join waiting lists for outpatient and inpatient services. It is disappointing that the best we can apparently do to try to resolve the current emergency department problem in acute hospitals is to threaten the waiting list for planned admissions. People who might already have been waiting for three years between outpatient consultation and inpatient admission will be told they must wait three months, six months or 12 months longer so that we can solve the problem in emergency departments. Is that a decent service in a decent republic? Does it amount to the provision of quality health care to people when they need it, irrespective of age, geographic location or ability to pay? No, it does not.

In regard to the length of hospital stays, Deputy Liam Twomey spoke about Chinese walls in hospitals. Unless it is the Great Wall of China, a Chinese wall is usually made of paper. The Government has had five years to take down those Chinese walls but has not done so. Why do we not have smooth administration within our hospitals? Why is the focus still not on the patient? There should be no Chinese walls. Members opposite speak as if these matters are beyond their control. It is within the Government's control to effect change; in fact, that is its job. Why was that not done over the past five years? Ministers can blame the hospitals and the professional bodies, but the fact remains it is the job of Government to change what it considers to be wrong. If Ministers cannot or will not do so, they should not be in office. It is very simple. We must get rid of the Chinese walls, if they are the problem, but the Government cannot continue to impose cutbacks while blaming those walls for the failure to create the infrastructure that is necessary to provide an effective service.

Ministers frequently make the charge that Sinn Féin Members criticise what they consider to be wrong but never present solutions. In fact, we have presented the Government with solutions, including a way to approach delivery of a quality health service in this country. The challenge for Government is to take on board the suggestions we have put forward. Unfortunately, on the basis of its so-called amendment to our Private Members' motion, it is clear that, once again, the Government is running away from taking effective action.

2:35 pm

Photo of Gerald NashGerald Nash (Louth, Labour)
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I thank Deputies for their contributions. We are all aware of people's concerns and frustrations regarding the number of patients on trolleys, the overcrowded conditions in which they wait for treatment and the difficulties in moving patients from acute care to long-term, community or home care. My colleague, the Minister for Health, Deputy Leo Varadkar, has spoken in detail on this issue and today updated the House on the range of measures being undertaken to address long waiting times and access issues in emergency departments and across our acute hospital services. The Government's commitment to address overcrowding is clearly reflected in the significant additional funding we provided last year and will provide this year. That extra investment has been used to support initiatives to increase hospital bed numbers, provide additional services to support early discharge of patients and help to reduce waiting lists for planned care so that today's cancelled operations do not become tomorrow's emergency presentations. Those extra resources are having an effect and we are seeing improvements.

However, we need to build long-term sustainability for our health service and establish full year-round demand and capacity planning. This must be supported by integrated care programmes between hospitals and social and primary care services. It is essential that the majority of people's care needs are met in the community setting and we are building towards that. In primary and community care, the roll-out of community intervention teams has provided care closer to patients in their own homes and communities. Community intervention teams are specialist nurse-led health professional teams which provide a rapid response for patients who need acute care in a short period of time. Care may be given in the patient's home, other residential settings or in primary care centres. Team members work closely with hospital and community clinicians to provide an integrated health care service. I have seen the system in action in my own community, particularly at Our Lady of Lourdes Hospital in Drogheda, and it works very well. In addition, the establishment of the college hospital transitional care unit has alleviated a great deal of pressure on Our Lady of Lourdes.

Community intervention teams help to alleviate the pressures on emergency departments by preventing unnecessary hospital admission or attendance and enabling early discharge of patients from hospitals, freeing up beds for other patients. The teams are having a real impact on patient care. Between January and October 2015, use of their services increased by nearly 30% compared with the previous year. Referrals from emergency departments and hospitals increased by some 21% and referrals from GPs by 47%.

GPs and potential patients would be advised and encouraged to make use of other facilities that are available, such as medical assessment units, minor injury units, urgent care centres and doctor on call services, to allow emergency departments to focus on patients who really need emergency critical care.

Hospital groups are being established in line with the Government's programme for reform of the health service. The objective is to ensure we have a health service that has the resources it needs, uses them efficiently and puts the interests of patients first.

2:45 pm

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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The Minister of State's party vehemently opposed them when it was in opposition.

Photo of Gerald NashGerald Nash (Louth, Labour)
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That is a significant reform, whether Deputy Kelleher likes it or not. The Minister for Health, Deputy Varadkar, has mentioned the need for accountability. The Government does not support the privatisation of hospitals, but it recognises that if hospital groups are to have more autonomy, they and their constituent hospitals must be held to account. Action will be taken if improvements are not secured and sustained. The organisation of acute hospitals into a small number of groups, each with its own governance and management, provides the opportunity to deliver high-quality, safe patient care in a cost-effective manner.

Hospital groups and primary care must work together closely. As the Minister outlined earlier, a good example of this has been the development and implementation of winter resilience plans, involving collaboration between hospital groups and community health care organisations throughout the current winter period. We will continue to prioritise enabling older people to remain in their own homes and communities for as long as possible, ensuring that appropriate residential care is available when it is needed.

Overcrowding in our emergency departments and long waiting times are not a new problem. Similar problems are seen in health services across the developed world. Northern Ireland has had its fair share of problems in recent years in respect of overcrowding, and unfortunately it has the worst record in the system in terms of meeting NHS targets. This Government fully recognises that overcrowding is, rightly, an issue of genuine public concern. There is no instant remedy; trolley numbers will continue to fluctuate seasonally and because of our demographics. The Government, the Minister, the HSE and those on the front line want to ensure that we continue to develop a service that has the capacity to respond, to flex and to stretch so that we can cope with seasonal surges. Now that the economy is recovering, we can tackle these problems. With the support of clinical directors, consultants and all the staff involved in the health service, we can secure the long-term solutions we need to address the overcrowding problem and respond to patients' needs in a safe, patient-centred way. I promise the House that the Government, the Minister, Deputy Varadkar, and the Minister of State, Deputy Kathleen Lynch, will continue to work hard to find solutions to this complex problem, which we can all agree has existed for far too long.

Photo of Mary Lou McDonaldMary Lou McDonald (Dublin Central, Sinn Fein)
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The Minister of State rehearsed the party line very predictably. We can agree on one thing, namely, that the issue of the health service should not be reduced to the status of a political football. There is a need for a conversation right across society about what kind of health service we want and how we can get to a universal system of health care that is free at the point of delivery. That needs to be at the core of the next general election. If members of Government and, perhaps, others go out and engage in auction politics, promising to decimate the tax base, they then need to explain how we will arrive at that universal health service - how we will finally end the scandalous situation of our accident and emergency departments, of waiting lists and of people in agony, some of them almost despairing, as they wait in real physical pain for treatment. I deal with people like that on a daily basis.

It is often said that the measure of a society is how it treats its most vulnerable. Arguably, the measure of Government is how it provides for the basic needs of its citizens, particularly those who are in a vulnerable position. If we apply that yardstick, it is a damning indictment, not just of this Government but also of previous Administrations. The Minister of State mentioned older people. In the midst of this crisis in our emergency departments, the very idea of elderly people lined up on trolleys, toe to toe, on narrow, clogged corridors, with insufficient nursing staff to care for them is truly shocking and intolerable. It is a most undignified way to treat any patient, never mind our elderly. These are people who built this State and paid their taxes, and now they find themselves at their moment of need - in some cases in their twilight years - when they most need the supports of the State and when they are weak and vulnerable, lying on a trolley in a hospital corridor. In the Orwellian world of Leo’s hospital horror, these elderly patients are lucky because they could be on a chair. Worse still, they might be forced to sleep on the floor, as happened in the Mater hospital in my own constituency.

In the course of this debate - this is not unique - I had a communication from one man whose name I will not mention, but who is watching this exchange. He wanted the Minister to know that he presented at the Mater hospital last Saturday morning with a suspected heart attack and spent 19 hours on a chair. Thankfully, he has now had his surgery and has had a stent inserted.

This is not about a political football; it is about the politics of failure. It is an ongoing failure, but at this time it is on the Government's watch. The situation at the Mater hospital has not improved. In 2011, when this Government came to power, there were 3,936 unfortunate people lying on trolleys in the Mater hospital. Fast forward to 2015 and the number rises to 4,704. That is the reality. Most people have their most critical and sometimes traumatic experiences in the health system in emergency departments. This is intolerable. I have no interest in having a partisan ding-dong across the floor of the House on these issues, although if that is what it takes to get them the attention and resolution they require, so be it. What I do want us to see in the course of the election campaign is an honest, costed discussion about how we get from chaos to stability, from a broken, banjaxed two-tier system to a single universal health care system. That is what Sinn Féin's plan addresses, that is what we want, and that is what we want to debate and - I hope - agree with the Government and with the people.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I thank all Members who have contributed during the course of today's debate. The Minister, Deputy Varadkar, made reference in his contribution earlier this morning to the budget 2016 commitments of the Opposition parties. He made false claims regarding his and his Government's budget 2016 commitments. I note that he acknowledges that Sinn Féin and Fianna Fáil recognised in the preparation of our pre-budget alternative submissions the crisis in the emergency departments and each provided €86 million to address measures needed this year. Fianna Fáil, as it does, rounded it up to €90 million. Nevertheless, we had provision within our alternative address of the crisis. The Minister went on to say it fell short of the €117 million the Government provided in 2015. It was the budget for 2016 that we were preparing. He goes on to mention "the further significant funding we are providing this year". What further significant funding is the Government providing this year?

3 o’clock

It does not show at all in budget 2016 announced by the Government in October. In fact, in the summary of the new expenditure measures that was presented in the Dáil by the Minister for Public Expenditure and Reform, Deputy Howlin, there is only €18 million in additional funding provided in budget 2016 for children's health and therapeutic services, totally ignoring the real crises that exist.

The Minister, Deputy Varadkar, states that my party's proposals on general practice would render some GP practices unviable. Contrary to the Minister's claims, we have real and substantive proposals for addressing the shortage of GPs and their current difficulties, and that is the issue the Minister is clearly missing. It is important to take on board that we propose increasing the annual training intake, from 161 to 200, to facilitate the growth in the number of qualified GPs. We want to broaden the attractiveness of general practice as a career choice. We want to see 200 salaried GPs brought in as a new measure, with support staff in the form of additional medical secretaries and 200 new practice nurses, in tandem with those specific practices being located in the areas of the country that are currently underprovided for, these being large swathes of rural Ireland and some deprived city areas throughout the State, not least in Dublin city.

I welcome the Minister's acknowledgement that our policy proposals, in terms of my party's new health policy launched before Christmas, contain good ideas, but he went on to state that they "would require a level of investment that is just not realistic". That is not so. Our policy is not only realistic but a no-choice situation. No doubt the Government wants to cut core taxation and put more excess spending power into the pockets of the already well-off. We want to ensure such investment is made instead in quality public services, and let the Minister be in no doubt that health and health care is Sinn Féin's No. 1 priority.

The Minister went on to state that "Sinn Féin's approach to policy is almost childlike". If that is the Minister's view, it is because the proposals we present are straightforward and uncomplicated and will work. The Minister went on to state that my party would put €5 billion into health. As it happens, over a five-year Dáil term we would increase spending on health on the base year of 2015 by a total of €10.5 billion, commencing with €794 million in 2016 and rising to €3.3 billion in the fifth year. These are important commitments.

The Minister, as highlighted by Deputy Kelleher, did not read into the record all that he had been offered. My point is he talks about developing plans recognising the range of difficulties. For heaven's sake, we all know the range of difficulties. It is the plans to address them that we want. The Minister seems to be averse to long-term thinking and I would ask him not to spend too long at it because it does not appear to be something at which he excels.

On the issue of the 30 days he has chosen to cite the statistics on the trolley watch figures, I repeat that there has been an increase of 21% in the position regarding the trolley and ward watch from January to December 2015 compared with the same period in 2014. For the record, there were 443 patients on hospital trolleys this morning, a very serious matter indeed.

On the provision for older persons, the Minister states that home help hours and home care packages were strengthened last year and will be maintained in 2016. We do not only want to see 2015 figures sustained in 2016; we need expansion. As our motion clearly states, we want to see a 10% increase in the expenditure on home care packages and home help hours, with a €31 million commitment in year one rising to €93 million over a three-year period. Those are the sort of serious measures that will address the problems that we currently experience.

On the position in the nursing home support scheme, the Minister speaks of an increase of €35 million on last year's so-called projected spend. It is interesting that the Minister chose such phraseology. What was the actual spend? Is there any increase at all on 2015? We, on the other hand, have committed to spending at least an additional €125 million to create the necessary additional bed capacity that will help to address the current situation of delayed discharges and the need for people to be able to access long-term care provision and to have the alternative of remaining in their home if it is safe and appropriate to do so.

The Minister stated that in January 2015 he set maximum waiting times for inpatient and day case treatment and outpatient appointments of 18 months by 30 June and 15 months by the end of the year. Of course, the Minister was increasing it to facilitate an easement in terms of the public focus on his failures to ensure the waiting times were being met. The Minister increased it to massage the figures. Let there be no doubt about it, in case there is any, that the situation as of the beginning of this month with inpatient and day case national hospital waiting times is that there are 746 waiting more than 15 months and 5,665 waiting more than 12 months. On the outpatient situation, there are 9,887 waiting more than 15 months - those whom the Minister promised would by now no longer be waiting more than 15 months - and over 12 months, a not unreasonable target to address, there are 37,197. Of course, the overall position is outpatients: 375,440, and inpatient care: 68,086.

I note the Minister concluded his remarks with, "I can assure the House of my ongoing commitment and interest ... and that of the Government". I wonder about the Minister's interest and I wonder what he was referring to in relation to the Government. Was it their ongoing commitment or was it just their interest? In the Government amendment, the Minister stated that "timely access ... continues to be a primary focus of Government policy", but what about Government action? Government policy is all very well; it is only on paper. What we want is the evidence that the Minister has a commitment to do it. What did the Minister actually mean by the phrase "Health will never be a good news story"? Why will health not be a good news story? Of course, it needs to be a good news story.

When we look at the Minister's 88 actions in addressing the ongoing difficulties within emergency departments, we should take a look at what he talks about. Not enough has been done on increased bed capacity in hospitals. Clearly, not enough has been done either on reducing delayed discharges from hospitals. On recruiting more medical and nursing staff into the health service, again not enough has been. I will not go on with the rest of the list but let me tell the Minister in unequivocal terms that his end of term report card clearly shows that he has failed.

Amendment put:

The Dáil divided: Tá, 59; Níl, 39.

Tellers: Tá, Deputies Emmet Stagg and Paul Kehoe; Níl, Deputies Aengus Ó Snodaigh and Seán Ó Fearghaíl.

Amendment declared carried.

Question put: "That the motion, as amended, be agreed to."

The Dáil divided: Tá, 57; Níl, 39.

Tellers: Tá, Deputies Emmet Stagg and Paul Kehoe; Níl, Deputies Aengus Ó Snodaigh and Seán Ó Fearghaíl.

Question declared carried.