Thursday, 9 March 2017
We, on this side of the House, extend our sincere sympathies to the family of Annmarie O'Brien and her daughter, Paris, on their tragic deaths in the fire in Clondalkin yesterday. We also extend our condolences to the family of Holly and Jordan, the other two children to die in the horrific fire. We pray that their mother, Biddy O'Brien, will fully recover from her injuries. The Garda and the Dublin Fire Brigade are continuing their investigations and it is in everybody's interests that the cause of the fire be established as soon as possible.
Dublin Fire Brigade provides emergency ambulance services in the Dublin city and county area by arrangement with Dublin City Council and the National Ambulance Service. Dublin Fire Brigade has a proud tradition of providing this fire-based ambulance service in the capital. International best practice indicates that combining fire, rescue and emergency medical services greatly improves the response to a crisis. In the Dublin Fire Brigade, 830 firefighters are trained paramedics in a position to provide immediate emergency medical assistance and the benefits of this integrated service are obvious to everyone. The chief executive of Dublin City Council, Owen Keegan, has stated he wishes to see a transfer of all call taking and dispatching of ambulances to the national control centre in Tallaght. He stated this was the view of the chief executives of the other local authorities, although it is not agreed by the councillors in those local authorities.
The HIQA report raised concerns about the operation of two ambulance services in the Dublin area and called for enhanced integration of service provision. It is clear, therefore, that co-ordination and integration between the Dublin Fire Brigade and the National Ambulance Service is required. Significant investment is also needed in the fire brigade and ambulance capacity in the Dublin area. Investment is needed in ambulances, personnel, vehicles and technology. Last Saturday, rallies took place at all the fire brigade centres throughout Dublin, which demonstrated the support for the retention of the ambulance service by Dublin Fire Brigade. Impact and SIPTU have called off strike action, following the intervention of Kieran Mulvey.
Does the Tánaiste agree that the ambulance service should be retained in Dublin City Council? The expert panel published its report in 2015 and made recommendations for the future of the ambulance service. This provides a mechanism for co-ordination and governance. I hope the relevant Ministers will deal with the issue once and for all. It has been dragging on for too long and we need action.
I join the Deputy in extending my sympathies to the families, the young children, the mum and her friend, who is seriously ill. I was saddened to hear about the tragic fire in Clondalkin and the circumstances surrounding it. My thoughts are with all of those involved, their relatives and friends. I am sure I speak for everyone in the House when I extend our sympathy to all the families. I spent time there this morning meeting the gardaí who are investigating, and further forensic analysis is being done. I met the staff of Sonas, which has been providing services for 25 years to women in vulnerable situations. They are devastated by what has happened. They are offering every support they can to the other families who, thankfully, escaped the fire. I also pay tribute to the emergency services personnel who arrived very quickly at the scene of the fire. We await the results of the forensic and Garda investigations. Today, our thoughts are with the relatives and friends of those who so tragically lost their lives.
The Dublin city manager informed the Department of Housing, Planning, Community and Local Government that SIPTU had served notice of potential stoppages on Dublin City Council on 6 May. The Departments have been heavily involved. I do not want this to go ahead. The Department is primarily concerned with ensuring local authorities are meeting their obligations in respect of their statutory fire service and fire safety responsibilities. The provision of health services, including the provision of ambulance services is, of course, the responsibility of the HSE operating under the remit of the Department of Health. A number of Departments are involved. We want to ensure any discussion on Dublin Fire Brigade and the ambulance services focuses on addressing the HIQA report issues. We must respect the excellent and proud tradition of Dublin Fire Brigade. The Minister for Health, Deputy Harris, and the Minister for Housing, Planning, Community and Local Government, Deputy Coveney, are examining the recommendations. It is critical that there be no reduction in front-line ambulance services and there is no intention that there should be.
I thank the Tánaiste. The expert panel on pre-hospital emergency care services Dublin published its report in 2015. Does the Tánaiste agree that the findings of the expert panel should be implemented as a matter of urgency, given that the report provides a mechanism to address the operational inefficiencies and the issue of a fully integrated ambulance service in Dublin? Will the two relevant Ministers commence immediately, by way of the new governance arrangements set out by the expert panel, a process to eliminate the shortfall in the Dublin Fire Brigade available capacity to meet demand in order that the use of fire appliances to respond to ambulance calls is reserved for calls that are clinically appropriate? Can the Department and Dublin City Council provide funding directly for the operation of the ambulance service provided by the Dublin Fire Brigade and can the funding be increased to reflect the costs of the service?
As the saying goes, "If it ain't broke, don't fix it." Nobody in the HSE has any capacity to take over the ambulance service currently administered by the Dublin Fire Brigade.
Will the Government and the two relevant Ministers intervene in respect of this matter, sort it out and leave Dublin Fire Brigade to continue to do what it has done for the past 100 years?
The first key point I will make to the Deputy is that we are investing more in the National Ambulance Service. I quite agree with Deputy Haughey that we do not want to lose any of the excellence and experience that has been built up over the years. We have a series of recommendations that will be discussed and considered by both Ministers. The funding considerations will form part of those discussions. The issue is clearly being taken very seriously by both of the Ministers and their Departments. Each of them has responsibilities in respect of it and funding is continuing. There will be no reduction in front-line ambulance services. That is critical given the demands on our hospitals. Yesterday, it was made clear in the House that engagement will take place when the recommendations come to the Ministers.
I wish to also express my deepest sympathy to the O'Brien family for the tragic loss of their three children and their sister in Clondalkin yesterday.
Of the homeless families in Dublin, 60% have been in emergency accommodation for more than six months and 40% have been in bed and breakfasts, hostels or hotels for over one year. There are 138 families who have spent more than 18 months in emergency accommodation and 40 families have now entered their third year of homelessness. Many of these families are living in inappropriate, unsuitable and insecure accommodation. As the Tánaiste knows, the number of complaints about the accommodation has doubled. Families are being forced into accommodation with damp rooms, bloodstained sheets, mice and even cockroaches. Can the Tánaiste, or any Member, imagine living with young children in these conditions for this length of time? Some of the 2,500 homeless children have spent more of their lives in emergency accommodation than in a stable home. Meanwhile some 198,000 homes lie vacant across the State. In Dublin, 40,000 homes are empty, which is almost 40 houses for every homeless family. This is not new information because we have known about it since the 2011 census, the same year the Tánaiste took office. Yet for five years during which the previous Government was in office, the Tánaiste did nothing to bring these homes back into use. That is why 1,200 families and 2,500 children are sleeping in emergency accommodation. It is also why there are 100,000 households languishing on the councils' waiting lists and why thousands of families who are facing home repossessions or spiralling rents are now at risk of homelessness.
The Government has started to take some action but the plans are not ambitious enough. They are chronically underfunded and they will not meet their targets. The Peter McVerry Trust is hosting a vacant homes conference today. The trust has nine policy recommendations it wants the Government to include in the upcoming vacant homes plan. The Simon Community has published a ten-point plan to tackle the unacceptable number of vacant units. Both of these groups are urging Government to do more to get empty homes back into use. My questions to the Tánaiste are very simple. Will she commit to studying carefully the recommendations of those two organisations? More importantly, will she commit to publishing a vacant homes plan that is ambitious and properly funded to provide the homes so desperately needed by those families in emergency accommodation and by those at risk of homelessness?
The Government plans are ambitious and funded. The Government recognises the significant challenges facing the housing market in Ireland. That is why we brought forward Rebuilding Ireland - Action Plan for Housing and Homelessness, which sets out a very practical and absolutely readily implementable set of time-based actions. This is what we are actually doing. It is a plan that will deliver for people by addressing the shortage of affordable housing, rising rents and the unacceptable high levels of homelessness. The reason we need to have Rebuilding Ireland is because of the disastrous and catastrophic policies which were followed previously and which led to the unprecedented property crash, for which we will be paying well into the future. This Government and that which preceded have acted on these issues.. We have been putting the money aside to deal with them and there has been practical and detailed engagement by the Minister, Deputy Coveney, and the Minister of State, Deputy English, with local authorities to ensure that housing will come on stream. That work is certainly under way.
I will now turn to the issue of the national vacant housing re-use strategy. First, as Deputy Ó Broin is aware, there is already a commitment to compile a register of vacant units across the State to identify the number, location and reasons for longer-term vacancies, that is units vacant for over six months in high-demand areas. There is a range of actions already being undertaken by the Government to bring those vacant houses back into use. The Housing Agency is due to report back on this measure within weeks.
Having said that, I wish to congratulate the Peter McVerry Trust for all the work it does. The trust is hosting a conference today at which it will be highlighting particular issues and also the measures designed to bring vacant properties into use. We will look at the range of recommendations that will emerge by the conference. A number of initiatives are already in place which are designed to bring vacant properties back into use. There is the buy-and-renew initiative, which facilitates local authorities to purchase and renew housing units in need of remediation and make them available for social housing. That initiative has funding of €25 million in 2017 and €50 million for next year. There is also the purchase by the Housing Agency of vacant buy-to-let properties on the portfolios of financial institutions and investor for use as social housing. There is funding of €70 million in place for that measure. There is a range of measures already in place. The vacant site levy will be charged from 2018 onwards, with the first bills being collected in 2019. The vacant site levy will ensure that the levy will be charged at the rate of 3% of the market value of the site. I mention this because it is associated. There are many initiatives already being implemented in order to ensure that those vacant houses come back into use. Every local authority is already working on that.
I know the Tánaiste has difficulty with housing statistics. She told the Dáil two weeks ago that 8,500 social houses were currently being built across the State but the Department of Housing, Planning, Community and Local Government's own figures clearly state that the figure is only 1,892. That is a very a big difference and I am sure the Tánaiste would like to correct the record of the House today. We would welcome her doing that. Just like the unambitious social housing programme, the Government's vacant home schemes are simply not enough. The three schemes spoken of by the Tánaiste promise to deliver, at best, 6,400 homes over six years. Even if the Government meets these targets - I do not believe it will do so - it is only 3% of the total vacant stock out there, and it will take six years, while we have thousands of children in emergency accommodation. There are 1,100 vacant homes available to buy from AIB, Bank of Ireland, Permanent TSB, and yet the Government is only purchasing 200 units.
On the "Morning Ireland" programme this morning, Ms Marie O'Sullivan from Cork pleaded with the Government to take action to ensure that she and thousands of families like hers do not become homeless. Will the Government finally accept responsibility for the housing crisis that the Tánaiste and her colleagues have created? Will they do more than the Tánaiste has currently outlined to ensure that families who desperately need homes do not end up in insecure and inappropriate emergency accommodation?
There are some other statistics that Deputy Ó Broin could have quoted, but which he would, of course, never quote, about the increased investment in this area. Budget 2017 provides for a 40% increase in the level of funding allocated nationally for housing authorities to manage homeless services - funding of approximately €98 million, compared to an initial provision of €70 million in 2016. That additional funding is so important in this area to support families who might go into homelessness. Another figure Deputy Ó Broin could quote is that housing authorities will have assisted in excess of 2,700 sustainable exits from homelessness during 2016. That is a record number of exits.
Clearly, there is enormous demand, but there are several other statistics which I have given the Deputy today, such as the €32 million available for the repair and leasing scheme. That will bring back into use 800 vacant properties as new homes for families on local authority waiting lists.
This funding is a front-loading of the €140 million being made available for the scheme over the next five years, and it targets 3,500 properties. Those are statistics the Deputy ought to be quoting.
Ireland is one of the leading countries in Europe for instances of phenylketonuria, PKU. Approximately one in every 4,500 babies born in Ireland has PKU in contrast to the United Kingdom, where the figure is approximately one in every 12,000, and further afield in the United States, where the condition is even rarer, affecting only one in every 15,000 newborns each year. In Ireland we follow diet-for-life, whereby each PKU sufferer is continuously assessed from birth to determine how many grammes of protein they can have on a daily basis. This assessment is determined from blood tests, as well as weight and height measurements and these tests are ongoing for life.
In order to facilitate the healthy growth and development of PKU sufferers to supplement the often very low amount of protein they can have, foods are available on prescription through the long-term illness scheme, for example, pasta, pizza, flour milk and bread. Despite the fact Ireland has one of the highest incidences of PKU in Europe, it has one of the most limited varieties of foods available on the long-term illness scheme in comparison with our European neighbours.
Given all of this, and in order to follow a full low-protein diet, it is necessary to purchase much low-protein food from supermarkets. Unfortunately, many of these foods, for example, Violife vegan cheese, fresh fruit and vegetables, are very expensive. The PKU diet is extremely challenging for PKU patients and their families, and the consequences of not adhering to the diet are very serious. Untreated PKU can lead to brain damage, intellectual disabilities, behavioural symptoms and seizures. Ultimately, facilitating PKU patients to adhere to their diet through the provision of a good range of medical and low-protein foods, as well as innovative medicines, will improve their outcomes, resulting in lower overall costs to the health care system, as well as optimising their ability to contribute to society.
As previously mentioned, we have a very limited list of foods available on the long-term illness scheme. Will the Tánaiste outline what is the long-term illness scheme budget for PKU products each year? How is this list managed and why is the variety of foods available in neighbouring countries not available here? Will it ever be a reality to have a PKU patient or their carer involved in the decision making around the foods available to them? PKU patients, who are the end-users, need to be invited to give their input as to the value or otherwise of foods of which they, after all, are the consumers. It needs to be acknowledged that some of the foods available on the long-term illness scheme are of much poorer quality than those available in other European countries, a prime example of this being the quality of breads, a staple of any diet. We should also note that an increased selection of foods of a better quality does not necessarily equate to increased costs.
I thank the Deputy. As we know, PKU is a very debilitating condition and sufferers must have an extremely low-protein diet to avoid the worst effects of the disease. In Ireland we have a very comprehensive screening programme because, as the Deputy rightly said, there is a very high incidence compared with other countries. What is a needed is a lifetime management process for patients who have this condition, known as diet-for-life, which provides continuous individual monitoring and assessment of patients.
Low protein and technical dietary items for PKU patients are available free of charge under the long-term illness scheme. The Deputy asked about the scale of that availability and about the amount of money allocated at present. The most recent data available show that expenditure on these products for one year from December 2015 to November 2016 was approximately €4.8 million. In 2016, an expert group was formed which was drawn from both hospital and community settings. Revised guidelines on the application for reimbursement of clinical nutritional products was looked at and in November last year, the HSE published those guidelines and suppliers were notified that the applications were being accepted. A number of new applications were received and it is hoped this will broaden the list of the products available. In January 2017 the expert group considered the applications that have been received and the applicants will be notified of the outcome in the coming weeks.
When a product is approved for addition to the reimbursement list, it is seamlessly available to a person with PKU under their long-term illness eligibility. The next opportunity for submitting applications for clinical nutritional products to be added to that reimbursement list is expected in June. As for the drug sapropterin, the National Centre for Pharmacoeconomics is currently considering a new application in that regard which it received in February. The HSE will be considering that and deciding on the reimbursement in regard to it.
The Deputy raises an issue which is of concern to a huge number of people throughout the country. Quite an amount of work has been done on this in terms of the recommendations of the working group being examined by the HSE, and decisions are expected in the next period.
I ask the Minister for Social Protection, Deputy Varadkar, to also listen to this part of my question. Domiciliary care allowance is a monthly payment for a child aged under 16 years with a severe disability who requires ongoing care and attention substantially over and above the care and attention usually required by a child of the same age. It is not means tested. Why do some PKU patients receive domiciliary care allowance while others are refused? What are the evidence-based criteria used by the deciding officers? Why do some families have to go through the appeals process? As all PKU sufferers suffer the same condition with the same restraints and consequences, why is there not a blanket domiciliary care payment for all PKU sufferers from birth to 16 years?
Given the increased costs for PKU sufferers over 16 years, it is likely that having received domiciliary care allowance up to this age, they will be in receipt of disability allowance when they apply for it after the age of 16. Obviously, with growth comes increased appetite, which equals increased costs. What are the evidence-based criteria used by the deciding officers in cases of sufferers aged over 16?
I will finish shortly, with the permission of the Ceann Comhairle. PKU is a genetically rare disease. The HSE wants to set up a working group to assess the reimbursement of orphan medicines and technologies, for example, Kuvan, which can greatly improve the quality of life for PKU sufferers. Has this group been put into action? The national rare disease plan recommends the setting up of a national budget to fund such treatments so there is no impact on individual hospital budgets, for example, at Temple Street hospital. Has the HSE made any progress to date? I thank the Ceann Comhairle for his indulgence.
Kuvan is the other name for the drug I mentioned earlier. That was first sought in 2009 and it was refused due to lack of evidence of cost effectiveness at that time. As I said, a new application is currently under way.
The Deputy asked about domiciliary care allowance, which is payable in respect of children under 16 years with a severe disability requiring care and attention. Of course, for those children receiving domiciliary care allowance, there will now be an automatic medical card, which is a very important support to parents in that situation which the Government announced last week.
In response to the question about children with PKU, the approach is that no specific disability automatically qualifies a child for domiciliary care allowance. Eligibility is based on the care needs, not on the disability per se. Of course, the reality with young children and adults who have PKU is that the condition can vary quite substantially. For example, the various food products and interventions can be very successful for one child but not for another.
When seeing the child, the medical assessor has to take all of this into account. It is medical assessors, who are qualified and experienced doctors, who examine the application and the supporting medical evidence and make the decision. The deciding officer reviews the medical evidence and the details of the child's needs as outlined in the application form and assesses the care needs of the child. It is a very individual assessment based on the individual care needs of the child, as opposed to a category like PKU, or indeed any other disability.
Will the Tánaiste give us her assessment of a detailed timeline of when we will hold a referendum regarding the repeal of the eighth amendment to the Constitution? I have seen quotes attributed to the Tánaiste, and I hope I do quote her incorrectly, that I agree with. The Tánaiste said "the Constitution is not the place to resolve complex issues like this". She went on to say that "it would be more meaningful to talk about what do you replace it with". I agree with both statements. We will vote in different ways on the Bill introduced by Bríd Smith, which the Green Party co-signed. I fundamentally sense that a 14-year prison sentence, which we have at present, is just a sign of the latest legal iteration of the difficulties that the original eighth amendment has caused.
We may be in agreement, though others may not, that the Citizens' Assembly has been doing very useful work. I believe that process has been helpful in terms of allowing people to come in to share ideas and views. Its members have one meeting to go and then they have a certain period of time to present their information to the House. A lot of people marched yesterday. Looking at how we do other things here, such as the water issue, which has gone to a similar Oireachtas committee to the one proposed for a referendum on repealing the eighth amendment, there is a tendency here for timelines to slip. People are already saying that there will not be a referendum this year and that it will more likely be next year. I believe it is important for us to have a reasoned debate and to respect both sides. That is how I come to any discussion. I have friends on both sides and with a whole range of different views.
I believe it is important for us to give some sense of direction around times. I would be interested to hear the Tánaiste's personal views as to what the timeline is. How long will an Oireachtas committee be given to report back? Is it just the committee that will be involved in that process or are there other mechanisms by which Members of the House could share their views? In the forming of a preferred option for the Government, how might the Government work with the other sides of the House? There are different views on all sides of this House on this issue. I believe it will better serve our people if we can have an approach on the referendum that continues in the House the dialogue that has occurred in the Citizens' Assembly. How do we do that? How do we achieve a reasoned debate in our public dealings?
Critically at this stage more than anything else, when will that happen? This Government's timeline is also in the public's mind. There is a real risk that we will end up frustrating a lot of people on all sides of the argument if we cannot order our business on this issue in a way that sees that work done within the lifetime of this Dáil. I would argue that that is a real risk at this stage. I am interested to hear the views of the Tánaiste. She has played a long role in women's issues in this State. As Tánaiste, she has a critical position. Can she provide us her detailed assessment of a timeline? When would a referendum be held and how do we get there?
With regard to the Bill before the House, the idea of a €1 sanction for the intentional destruction of human life and of a Bill that would take away all discretion from a judge who would be dealing with such matters is not the direction we should go in. I believe that taking away all discretion from a trial judge is completely wrong. I believe that that Bill would protect abusers and people who order abortifacients over the Internet and use them inappropriately. That is certainly not the direction for us to go in. I do not believe this issue should be dealt with in a piecemeal fashion by changing some of the legislation we have in place at present.
As the Deputy said, this is an extremely complex issue. I recognise the very deeply-held views on every side of this. We all care deeply about this issue. I was part of the last Government that dealt with this issue for the first time properly in legislation through the Protection of Life During Pregnancy Act 2013, which regulated access to a termination of pregnancy if a woman's life was at risk from a threat to her physical or mental health. We all know there are many concerns at present for women, particularly regarding fatal foetal abnormality, cases of rape, incest, as well as very complex issues we undoubtedly need to address in this House.
The Government has set up the Citizens' Assembly. Like the Deputy, I pay tribute to the work of that assembly. It has been extremely thorough. We will certainly all have to get the full report from that Citizens' Assembly in order to be as well informed as the members of that assembly are at present following the detailed discussions they have had. It has been a very worthwhile process. It will be extremely worthwhile to see what they recommend. The assembly has dealt with it as the first issue on its agenda at the request of the Government. That is important. The issue has been debated many times in this House over the past number of years but the approach the Government has taken at present is to establish the Citizens' Assembly to review Article 40.3.3°. I certainly look forward to the outcome of that examination of Article 40.3.3° and to participating in the arrangements we will make in the Oireachtas. Clearly, we have said that we will set up a special committee. We have had good precedence with regard to that. The committee that Senator Buttimer chaired at the time had very respectful and inclusive discussions. I expect that is what will happen based on the outcome of the report from the Citizens' Assembly, which will be with us in the near future. It will then be up to the Oireachtas committee, the Business Committee and all of us to consider the best way forward in terms of the discussions in the House and whether a referendum will follow from that.
I will not get into an argument today about the Bill before the House, save to note that while I respect the Tánaiste's view, I have a similar competing view that a 14-year sentence is not appropriate in our Statute Book. I will put that matter aside. The Tánaiste's party has a particular responsibility in this issue given that it was her party that introduced the original referendum in 1983 against the advice of the Attorney General at the time, who saw, articulated and raised concerns about the legal difficulties that it would present. I do not disagree with anything the Tánaiste said after that.
I return, however, to the core question. I believe it is important for Deputy Fitzgerald, as Tánaiste, Minister for Justice and Equality and as a women who has played an important role in the whole issue of women's affairs, to outline what her expected timeline is for the referendum. It is important to get a calm and good quality debate in public, as well as within the Citizens' Assembly and in the Oireachtas committee. There must be some sort of understanding among the public what the timeline is. Can the Tánaiste address that key single question I asked? What is her expectation as to when a referendum might be held? Given that the Tánaiste said that the Constitution is not the right place to address complex issues like this, when does she intend to rectify that matter?
Let us look at what the Government has done already. The matter has been referred to the Citizens' Assembly. The timeline we are operating to at present is that we will have the report from the Citizens' Assembly in the first half of 2017. It will then be referred to the committee, which will be expected to report back within six months. That is the current timeline that we have, which brings us towards the end of this year. It will then be a matter for the Business Committee to decide how the issue will be taken forward in the Dáil for further Oireachtas deliberations. Those are the details of the timeline that we have at present. The report from the Citizens' Assembly is due in the first half of 2017, the special Oireachtas committee is to report back within six months and then other decisions will follow from that, including the very important debate here in the House.