Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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We will now take Leaders' Questions under Standing Order 29. I call Deputy Micheál Martin.

Micheál Martin (Cork South Central, Fianna Fail)
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Again this week we have had a very tragic situation. I refer to the deaths of two babies in the same maternity unit in the space of a week and to the news of the tragic death of a mother who lost her life in Holles Street on 8 May last. It has to be said that the vast majority of pregnancies in Ireland are safe and uneventful. Nonetheless, the recent deaths will create further uncertainty. It is clear that issues arise from them. These deaths follow earlier deaths in other hospitals, including Portiuncula Hospital and the Midland Regional Hospital in Portlaoise. It is worrying that they follow four deaths in 2014-15. It is of particular concern that we have not yet had sight of the four reports that were done. In other words, we do not have a clear idea of what transpired because the reports in question have not been published. That is unsatisfactory. A former Minister, Senator James Reilly, indicated that he would ask HIQA to undertake an independent review into a death in Cavan, but that never happened. I note that in the Holles Street case, just one external person is involved in the internal review that is taking place. We need external reviews of these issues to provide certainty.

I will explain why I am worried. I have read the two reports that were published following the review carried out at South Tipperary General Hospital and the review carried out by a management consultant at Cavan General Hospital in July 2015. I have also read the maternity strategy and the presentation made by Dr. Sam Coulter-Smith to the Oireachtas some time ago, in which he made the point that "Ireland had the highest birth rate in Europe between 2004 and 2013, yet we have the third lowest number of consultant obstetricians per 100,000 women in the population, among 34 OECD countries". All of the reports consistently refer to a lack of resources, to fundamental problems in the recruitment of clinical and managerial staff in the key obstetric centres and to fundamental manpower and resource issues. We have had many warnings and reports, but no comprehensive action has been taken to deal with the resourcing of our maternity hospitals. Does the Taoiseach accept that our maternity services are under-resourced? Does he accept that there is a need for urgent intervention and transparent action on the part of the Government?

Enda Kenny (Mayo, Fine Gael)
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When a death like this occurs, either at birth or in giving birth, it is always a source of stress and tragedy for the families involved. Obviously, the death of Mrs. Malak Thawley in the National Maternity Hospital was a very stressful time for her husband, Alan, and their extended family. I am aware that in this case, the HSE has confirmed that the master of the National Maternity Hospital has commissioned a full investigation into the circumstances surrounding the death of Mrs. Malak Thawley. This is as one would expect. I want to stress the importance of patient confidentiality and sensitivity to the needs of this family at this time.

The Deputy also raised the deaths of two babies at Cavan General Hospital. On behalf of everybody, I would like to express deepest sympathy to the two families involved. The HSE has confirmed that the RCSI hospital group is conducting a review of both of these cases. I assure the House that the safety and quality of maternity services is a priority and will remain so for the Government and for the Minister for Health. Deputy Martin will be aware of the publication of Ireland's first-ever maternity strategy, which demonstrates a new and enhanced focus on maternity care at policy and service delivery levels.

Timmy Dooley (Clare, Fianna Fail)
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The Taoiseach needs to turn off his guitar.

Enda Kenny (Mayo, Fine Gael)
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This document sets out how we can improve and promote maternity and neonatal care in the years ahead in order to ensure such care is safe, standardised and of a high quality. The Minister for Health and the Department of Health are working with the HSE to ensure the full implementation of the strategy. Since December of last year, each maternity hospital, including Cavan General Hospital, has been publishing a monthly patient safety statement, as recommended-----

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I ask the Deputy whose telephone is interfering with the microphones to silence it, please.

Enda Kenny (Mayo, Fine Gael)
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It is not my telephone.

Timmy Dooley (Clare, Fianna Fail)
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There is a bit of feedback on the electric guitar.

Micheál Martin (Cork South Central, Fianna Fail)
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It is the Taoiseach's telephone.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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The Taoiseach can continue.

Enda Kenny (Mayo, Fine Gael)
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Gabh mo leithscéal.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Okay.

Enda Kenny (Mayo, Fine Gael)
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Every maternity hospital is now publishing a monthly maternity patient safety statement, as recommended in 2014 in the Chief Medical Officer's report on prenatal services in Portlaoise. I can also report that the draft scheme for the health information and patient safety Bill will provide for mandatory external reporting of serious reportable events that arise in the health service. The Bill, which is currently with the Chief Parliamentary Counsel for drafting, will require health service providers to report such events to the State Claims Agency, the Health Information and Quality Authority and the Mental Health Commission. The Department is aware of four infant deaths which occurred at Cavan General Hospital's maternity services between 2012 and 2015. Each of those deaths is the subject of a review. I understand that one of the reviews has been completed and two others are at an advanced stage. The early completion of these reviews is obviously important for the families concerned. It will ensure any lessons to be learned will be implemented in our maternity services. I will deal with the recruitment situation in my follow-up reply.

Micheál Martin (Cork South Central, Fianna Fail)
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The Taoiseach's response is unsatisfactory because it does not cut to the core of the question I asked about the under-resourcing of our maternity and obstetric services. My understanding is that maternity services received just €3 million in additional funding in 2016. I always said that last year's budget was a false and fraudulent one in terms of public figures. Adequate provision was not made for the implementation of the strategy. I put it to the Taoiseach that this is a recurring theme in all the key presentations to the Oireachtas by those involved and in the various reports.

To quote Dr. Sam Coulter-Smith: "All of these factors combined have resulted in all hospitals having difficulty retaining and recruiting quality staff...resulting in an over reliance on locum and agency staff," and this is a key recurring theme.

The Taoiseach made reference to the legislation and I put it to him that in situations such as this we should have independent reviews of the incidents rather than internal reviews. Legislation is not needed to do that. The Minister could intervene and ensure that it happens. HIQA or an external independent review of the incidents would give certainty and confidence. Does the Taoiseach find it acceptable that in the four deaths between 2012 and 2015 we have, as yet, no information regarding those and no published report?

Enda Kenny (Mayo, Fine Gael)
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One of the reviews is complete, as I said, and two others are nearing completion. I am just as anxious that these would be expedited. With regard to independent reviews I believe it is important to first of all have the internal review completed under the systems that apply. If an independent outside external review is then necessary, that can happen.

By the end of March 2016 overall health service employee numbers had increased by 5,856 over last year, an extra 1,300 in the first quarter of 2016 alone, and most of those are front-line positions. During the last 15 month period the numbers employed in acute hospitals increased by about 3,500 wholetime equivalents which represents a 7% increase in the workforce. Deputies are aware that the expenditure in the area of health is over €13 billion at the moment. Numbers in the medical dental category increased by almost 600 wholetime equivalents, or 6.5% during that period and nursing figures rose by 1,700. Yes there are shortages in areas like emergency medicine, anaesthesia and psychiatry but these are not specific to the Irish health system. Alternative marketing strategies are being developed by the HSE for these hard to fill posts to encourage people to take up employment. There has been a significant increase in the number of consultants working in the public health service. Since the establishment of the HSE the numbers have increased by over 850 to 2,761. This is a matter of considerable focus by the Minister.

A mediator has been appointed to look at the question of a difference of opinion between the National Maternity Hospital Holles Street and St Vincent's Hospital. Money is in place, planning permission is in place and rows like this should not impede the provision of proper, high standard, quality care for mothers using maternity services.

Gerry Adams (Louth, Sinn Fein)
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It is clear that the Government intends to continue in this term exactly as it did in the last. Fianna Fáil stands indicted for giving the Government an opportunity to do this once again. Despite protestations to the contrary the Government clearly intends to ignore the real life crises faced by many people, just as it did before. The Government's responses to the crisis in our health services and the housing crisis, to deficiencies in An Garda Síochána, to the NAMA scandal and to the plight of rural Ireland are exactly the same as they were for the last five years. First of all the Government denies there is a problem and then it announces half measures wrapped up in fine rhetoric. Yesterday’s announcement of measures to tackle organised crime is a good example. These modest measures, while welcome, do not go far enough. Following the Regency Hotel murder, the Government line was that Garda resources were not an issue when it comes to tackling organised crime. The task force announced yesterday would be welcome if it meant additional and extra resources, but does it? In north inner city Dublin there are 140 less gardaí than in 2010. Unless there is an increase in Garda numbers this task force will be made up of gardaí brought off the front line elsewhere. This lack of resources is not an accident and is not unique to Dublin. It is an issue right across the State. It is a direct result of the policies of this Government and of Fianna Fáil before it and needs to be totally reversed. Will the Taoiseach indicate to the Dáil when the new measures announced will be in place and will there be additional gardaí and funding?

Enda Kenny (Mayo, Fine Gael)
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First of all Deputy Adams let fly at Fianna Fáil, then he mentioned health, housing, rural Ireland and An Garda Síochána so I am not sure if the Deputy expects me deal with all four topics in the very short time I have here.

Gerry Adams (Louth, Sinn Fein)
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Just answer the questions I asked.

Enda Kenny (Mayo, Fine Gael)
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The Deputy only asked one question.

Gerry Adams (Louth, Sinn Fein)
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I could put them to you again.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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There is no need.

Enda Kenny (Mayo, Fine Gael)
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The Deputy mentioned health, housing, rural Ireland and the Garda situation. Five years ago we inherited a situation where there was not any money, Garda recruitment had come to an end and Templemore was closed. There has been this festering situation in north inner city Dublin and in other locations around the country for quite some time. Government began to put resources, where possible, into the security forces in both Defence and the Garda. Templemore was reopened and began to recruit gardaí. In our programme for Government we set out an increase of recruitment through Templemore to have a real increase in Garda numbers to 15,000 and to cater for vacancies created by those gardaí who have retired on age grounds.

We have made it perfectly clear on many occasions that whatever the request made by the Garda Commissioner or the Garda authorities for dealing with gangland crime, those resources would be provided. One can only do that with a strong economy and that is why it is important for the management of the public economy be kept very clearly in sight. We discussed this at Cabinet having met with the Garda Commissioner and senior Garda personnel last week. The Criminal Assets Bureau, CAB, made a specific request that the threshold which applies under the Proceeds of Crime Act 1996 should be reduced from €13,000 to €5,000 and we are going to do that. By way of regulation, the Government decided on the advice of the Criminal Assets Bureau to reduce the prescribed sum under which cash suspected to have been the proceeds of crime can be seized from €6,500 to €1,000 under section 38 of the Criminal Justice Act. Further proposals will go to Government to enhance and update legislation for the lawful interception of communications in respect of criminal activities.

Last week I said this matter goes beyond mere party politics. It affects the lives of innocent people and we understand the fear and pressure that these communities are under. The Garda will have the task force on crime for all of Dublin. We are going to respond with a task force for the north inner city. I expect to have consultations with Deputy Adams and Members of different parties who might have ideas about that and then go and talk to the community leaders and public representatives in the north inner city to look at the social disadvantage, the unfairness and lack of facilities in those areas for very many years. I am glad to see that the new primary care centre is about to commence in Summerhill and have a sod turned very shortly. However, it needs so much more because this is not something that can be dealt with overnight. There is a much longer term requirement for initiative and investment. Consultation and working with these communities, where very good people are committed to giving the children of the localities a life of opportunity, is needed. This means that whatever Garda resources are required, on the advice of the Garda Commissioner, will be provided. The Government has made that money available and is following through with these actions which will not of themselves put an end to this but they will help the Garda authorities, the gardaí on the ground and the communities to come to grips with this scourge.

Gerry Adams (Louth, Sinn Fein)
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It is good news that the Taoiseach has discovered there are problems in some of our communities caused by criminal gangs and I am sure the people who are victimised by these gangs are delighted the Taoiseach has this new knowledge. I asked three questions. When will the measures announced yesterday be put in place? Will there be additional gardaí? Will there be additional funding? The Taoiseach did not answer any of the questions. It is crucial that additional gardaí are on the ground and that An Garda Síochána is resourced properly. However, this is not just a policing matter. There is a need for increased investment in education, job provision, drug treatment and crime prevention. Local communities are up for this challenge. Many have battled for their kids for generations against Government indifference and now the Government has discovered there are disadvantaged communities within earshot of the Dáil. The Government now needs to deliver, go beyond the rhetoric and put real measures in place. Last week I asked that a task force involving local communities be put in place, Government led but with full involvement of local activists and local people to carry out a comprehensive, multi-agency strategic plan for DubIin’s north inner city. When will this be put in place, how will it be resourced and what funding will be provided? I remind the Ceann Comhairle that the Taoiseach has not answered my original three questions.

Enda Kenny (Mayo, Fine Gael)
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Let me reflect again for the Deputy. We already had the capacity to reopen the Garda College in Templemore to train new gardaí and dispense them around the country. The Government has decided to increase the Garda force to 15,000, but we cannot do this without a strong economy or providing proper training for young gardaí. As the Deputy will have known within the past few days, probationary gardaí are supervised in their training; therefore, we do not have situations which arose in the past when that was not the case. An extra €5 million has been provided to deal with the request from the Garda Commissioner in terms of the labour intensity of surveillance, dealing with gangland crime, interventions and the prevention of shootings or attempts to kill people. This is something with which the Garda force, in particular the Garda intelligence unit, has been dealing for quite some time. I accept that it is necessary for government as a whole to work with communities such as those in the north inner city to give them some chance and have a real opportunity. We would not be able to do this if we did not have resources in the economy to make some impact. In the past we have been blamed for being too focused on the economy. Believe me - we will go there, but we have to know how to link all of the agencies together, what the purpose of the north inner city task force is, what resources are required and what it is the leaders in these communities want.

Gerry Adams (Louth, Sinn Fein)
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There are more questions than answers.

Enda Kenny (Mayo, Fine Gael)
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Public representatives of all parties and none will have a voice. If it is to be a whole-of-government response, it should be so. It is not only this party or the Government that wants to deal with this. It is about the people. Those in the north inner city are good people and should have the same opportunities as anyone else to live their lives in the way they want.

Maureen O'Sullivan (Dublin Central, Independent)
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Dublin's inner city has had an horrific time recently. While other parts of the country have, unfortunately, experienced murders, I think we accept that it has been unprecedented in the north inner city. As Atticus Finch put it in To Kill a Mockingbird, one never really understands a person or a situation until one gets into their skin and walks around in it. That is what I am asking for - that the Taoiseach get inside the skin of somebody living in the north inner city. He or she looks out the window and there is no one on the street, yet, within two to three minutes, anything from 30 to 60 people are on it because the word has gone around that drugs will be available for sale. He or she could be sitting at home in his or her flat or walking down the street, perhaps going to buy the messages, meet neighbours or the pub for a drink, and, suddenly, shots ring out and somebody is gunned down and executed in front of him of her. He or she could have a son or a daughter, a brother or a sister, who got caught up in addiction and owes a massive amount of money to the dealers and he or she hears a knock on the door and is told either to pay up or else do a deed, commit a murder or set somebody up for murder or the consequences will be worse for him or her.

Middle Ireland and wealthy Ireland have contributed to this also. They have also fuelled the drug trade and thus contributed to the murders and mayhem. We know that it did not happen overnight. It is continuing and will continue. As long as it continues, it will undermine the rule of law and democracy. Tackling criminal justice issues, increasing the police presence and enhancing the Criminal Assets Bureau are welcome, but that is only part of the answer. It will not resolve the more fundamental issues that have been neglected for decades. The bigger reality, as we all know and the Taoiseach said, is that people face disadvantage and inequality, whether in education, job creation, service provision or the environment, yet, as the Taoiseach also said, these communities have shown great resilience, pride and humour. I acknowledge the work that has happened. In spite of cuts of 30% to 40% for community, youth and addiction services, the work has continued in schools. There is also the role of the churches, as well as the community policing forum and community police officers.

Does the Taoiseach accept, as I am sure he will, that it is the duty of the State to protect its citizens? Does he accept that everyone - individuals, families and communities, regardless of where they live - has the right to live in peace, free of fear, intimidation and violence, and to live in a place where the State does not just talk about equality of opportunity but actually puts strategies in place that are well resourced and make a difference?

Enda Kenny (Mayo, Fine Gael)
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I accept that, of course I do. I understand, from Deputy Maureen O'Sullivan's experience as a public representative and citizen, that she knows more than most and knows many of the people involved in the north inner city directly. I respect this. The agenda she has set out is part and parcel of what we have to do. It is, of course, the duty of the State to ensure citizens are protected. It is a duty of the State to ensure citizens can go about their daily lives free of fear and pressure such as that experienced in the north inner city. However, it also has a duty to connect all of the interdepartmental agencies together. Whether it be in justice, housing, education, training, upskilling or apprenticeships, an opportunity has to be provided for young people and those who in the past might have taken a different route. It is a major challenge. When this was done in Limerick, the restoration projects took ten, 15 or even 20 years and required an enormous amount of money. We have to start by resourcing gardaí to do their job. As the Deputy knows, arrests have been made and there are investigations ongoing into the unfortunate murders. There is much more evidence on the streets and people have been warned that their lives are in danger because of the intelligence being made available to gardaí. We hope it can and will stop. In so far as the Garda is concerned, its crime task force will be resourced and given whatever facilities the Commissioner requests. The State, public representatives, community leaders and communities will need joined-up thinking, backed up by resources, to provide evidence that, for these communities, having hope is not just an aspiration but can becomes a reality in terms of facilities, opportunities, the provision of training, paths to employment and hope for a better life.

Maureen O'Sullivan (Dublin Central, Independent)
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There have been numerous task forces, strategies and reports, many of which are gathering dust on the shelf. We are now talking about a new task force. As the Taoiseach said, it needs to have key players from the statutory organisations, but they have to be key players with direct access to Ministers. The Department of the Taoiseach also has to be involved, perhaps as the driver. There must also be experienced voices from the community and voluntary sector. Allied to this, to make a difference, there has to be an implementation, monitoring and evaluation team that will have specific short-term, mid-term and long-term objectives and timeframes. We need better and more effective international co-operation, which is vital to target assets.

We need a better understanding of addiction. One of the unintended consequences of the police action is that the drugs supply for many with an addiction will be cut off. Here is an opportunity for them to get into recovery programmes, if treatment and rehabilitation services are available to them. There needs to be an increase in detox facilities, whether community or residential. We need more gardaí, but we also need more youth workers, community and outreach workers. Education is vital, while prevention and education present a major challenge. This means engaging young people, as we have done in the north inner city, in meaningful and non-judgmental conversations.

I acknowledge that this is both complex and difficult. There are no quick-fix solutions and it is going to be a challenge. Nonetheless, there is a real opportunity. This issue is going to move from the media because they will have other stories. However, we cannot afford to lose focus because, if we do, the trail of addiction and crime, including gangland crime, will continue.

Enda Kenny (Mayo, Fine Gael)
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I thank the Deputy for her contribution. I like to think the north inner city task force that will be put together will be different in the sense that I would like to see it modelled on what the Minister, Deputy Richard Bruton, brought forward formerly in the creation of jobs, where there was a timeline, it was action-proofed and responsible. In so far as my Department is concerned, we will be very happy to work with it.

The Minister for Health explained yesterday that he hoped to be in a position, before the House rose for the summer recess, to bring legislation to the House dealing with prescriptive drugs, a matter mentioned by Deputy Róisín Shortall on a number of occasions and others. Before the end of the year we will have a national drugs strategy, with which the Minister of State, Deputy Catherine Byrne, will deal, in conjunction with other Departments.

The points raised by Deputy Maureen O'Sullivan are real and part of an agenda of opportunity for communities, but it is our job to make it happen. I hope to engage with the Deputy and others, including members of the Government with their different responsibilities, to address the need for joined-up thinking and to show that, where the Government applies itself with resources, it can make a difference to the lives of people.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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That concludes Leaders' Questions. We move to questions to the Taoiseach.

Brendan Howlin (Wexford, Labour)
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On a point of procedure, I was not notified that there was to be a change in the order today-----

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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11 o’clock

There was communication with the Deputy's party.

Brendan Howlin (Wexford, Labour)
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With whom?

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I am not sure but I understand that there was communication with the Deputy's party.

Brendan Howlin (Wexford, Labour)
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It certainly did not arrive at my desk. To ensure that we understand, the Ceann Comhairle might explain his ruling to the House as everybody would need to know.

Michael Healy-Rae (Kerry, Independent)
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They told Deputy Alan Kelly.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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This matter was discussed at the Dáil reform committee.

Brendan Howlin (Wexford, Labour)
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No, I understand the Ceann Comhairle's ruling for today on a party-----

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Yes.

Brendan Howlin (Wexford, Labour)
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-----but how can a party of seven take precedence over an existing party of seven?

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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We will not have a debate on that-----

Brendan Howlin (Wexford, Labour)
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It is a very simple question.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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-----at this point. The Deputy knows there is to be a follow-up meeting of the Dáil reform committee-----

Brendan Howlin (Wexford, Labour)
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The question is very simple

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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-----on Thursday. We are not going there. We are moving on to questions to the Taoiseach.