Billy Kelleher (Cork North Central, Fianna Fail)
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It is my duty as an opposition spokesperson to raise the issue of health services and the dire straits in which the services being provided across the country or not being provided are. We now have a situation where community, hospital, primary care and mental health care services across the country are simply not able to cope with the demand. Some 7,781 admitted patients were on trolleys in the month of August alone. That is up 27%. There were over 440 people on trolleys in our emergency departments yesterday, admittedly down today to 345, but still an extraordinary figure for this time of the year. Over 65,000 people were treated on trolleys during the first six months of 2017. By any credible stretch of the imagination, the Tánaiste now has to accept that this Government, despite giving itself applause and claps on the back about the biggest budget it has provided for the health care services, is not providing the health care services that are required.

Will the Tánaiste accept that this Government has been lethargic, at best, in trying to deal with the challenges in the health care services, and primarily in the acute hospital setting? We now have a situation where, week on week, we have record after record being broken with regard to overcrowding in our emergency departments and the number of people in outpatient and inpatient services is now nearly at 700,000. Our acute hospital system is in crisis. Couple that with challenges in primary care and we are going to have a winter in which there will be an awful lot of pressure on our emergency departments. Elderly people in particular will be waiting inordinate periods to be admitted to hospital. Is it now time for the Government to accept that its winter-proofing systems that have been in place for the last number of years have been an abject failure and that it requires a hands-on approach from the Minister and Government along with the Department of Health to deal with these challenges? I do not think it is good enough for the Taoiseach, Tánaiste and others to stand up and say they are providing the largest budget in the history of the State for health care. If they are, they are failing, because it is simply not providing the services that are needed and required across the major areas, namely, the acute, primary, community care and mental health areas. By any credible yardstick, this Government's health system or health services are failing on a daily basis.

Will the Tánaiste accept that there needs to be a refocusing by the Minister for Health and the Government to prioritise the key areas of the acute hospital, the emergency departments and our primary care setting to ensure that, come the winter, we will not have hundreds of people on a daily basis in our emergency departments across the country, and primarily elderly people, which seems to be the case at the moment?

Pat Gallagher (Donegal, Fianna Fail)
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I thank Deputy Kelleher for observing the time. He has set an example for others.

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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The Government is focusing on the priority areas in health. For example, reducing waiting times for the longest waiting patients is one of the Government's key priorities. It is for that reason that €20 million was allocated to the National Treatment Purchase Fund, NTPF, in the budget, rising to €55 million in 2018.

In order to reduce the numbers of long-waiting patients, the Minister for Health, as the Deputy will be aware, asked the HSE to develop waiting list action plans for 2017 in the areas of inpatient care, which the Deputy mentioned, and also scoliosis and outpatient services. The inpatient, the day-case and the outpatient plans focus on reducing the number of patients who are waiting 15 months or more for inpatient and day-case treatment or for an outpatient appointment by the end of October.

Working very closely with the HSE, the NTPF has been implementing waiting list initiatives to provide treatment for those who are waiting longest on the inpatient day-case waiting list. The August 2017 day-case and inpatient waiting list figures which were published at the beginning of September show that the total number of patients waiting has fallen by over 2,000. Every case of a person waiting is one too many but the Government is focusing on the range of initiatives which are making a difference and will make a difference in the long term. These include, of course, the bed capacity review which is really important and the GP contract so that we can have more focus on primary care centres.

Let me give Deputy Kelleher the statistics. Some 23,000 patients have come off the inpatient day-case waiting list and over 81,900 patients have come off the outpatient waiting list. Also, 237 scoliosis surgeries have taken place. The NTPF is rolling out the day-case initiative as well. That is focused on those waiting longest for day-case treatment. Right now, 2,000 patients have accepted an offer of treatment from the NTPF. All those initiatives are beginning to have the kind of impact we want to see.

Deputy Kelleher also mentioned the winter initiative. There is a range of initiatives to deal with the very real increase in referrals that takes place in the winter period. Following on from last year's winter initiative plan, the HSE, in conjunction with the Department of Health, developed a roadmap for improving the patient experience and to reduce the number of patients waiting for admission on trolleys in order to provide a better response. Each of the hospital groups has been working to progress a very proactive integrated approach around winter resilience planning for 2017-2018 to ensure that specific plans are in place for those predictable peaks of pressure that the Deputy has spoken about.

Billy Kelleher (Cork North Central, Fianna Fail)
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The day-case reductions are because of the National Treatment Purchase Fund and the intervention which is part of the supply and confidence arrangement. That is one part of policy that is working. Unfortunately, it was a policy the Government did not want to pursue, but it is there. It is proof that if there are imaginative ways, issues can be addressed. When one looks at the day-case waiting list, there is a reduction solely because of the National Treatment Purchase Fund.

The difficulties are in the emergency departments on a continual basis. The reason I raise this is we are now in September and if the trends continue, we will have significant problems in December, January and February - during the winter months. We know that but there is little being done to address these particular pressure points.

The Tánaiste can talk about the overall budget but I refer specifically to emergency departments, the acute hospitals and primary care. We now have a situation where the primary care services across the country simply cannot cope. The idea that one would get an appointment the same day with one's local GP is now a thing of the past. They are overwhelmed and under-resourced. If the Tánaiste could, she might just revisit the two issues of addressing the pressure points in the acute emergency departments and to try to come up with imaginative solutions to support primary care, primarily the GPs, so that they do not have to refer patients to hospitals as much as they are forced to at present due to lack of resources.

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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I repeat that the development of new primary care health centres is a priority for the Government. As Deputy Kelleher will be aware, funding has been allocated. The Deputy will have seen the centres that have already opened.

Clearly, that has to be a huge part of the focus in making sure there are appropriate referrals to emergency departments. The renegotiation of the GP contract is a key part of dealing with the pressures that are very evident in GP practices throughout the country. Attracting and retaining staff in GP practices must also be a focus in order to ensure we will have local primary care centres. There is an absolute focus on the development and opening of new primary care centres throughout the country to deal with the pressures. Appropriate referral is obviously one of the key parts, but there are also the initiatives that have been taken in different hospitals. I point to what is happening in Beaumont Hospital as an example in that regard. It is very clear that there are hospitals which are dealing with the huge pressures they are under by developing new systems of management. They have also been given extra resources.

Pat Gallagher (Donegal, Fianna Fail)
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Deputy Mary Lou McDonald is next and I know that she will lead by example.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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As ever.

We are three weeks away from the announcement of budget 2018 which represents a real opportunity to deliver for citizens who are struggling to get by and build a life for their families but all of the signals from the Government and the Taoiseach are that they are going to pass up on this opportunity. Instead of focusing on the crises in the health service and the provision of housing, Fine Gael and Fianna Fáil are engaging in a sham fight over how best to introduce unaffordable and reckless tax cuts. It is the same old Fine Gael backed by the same old Fianna Fáil. We all know that the best way to give a break to those struggling to make ends meet, pay rent and keep a roof over their heads is not to give a tax break to put a few measly euro back in their pockets, a few measly euro that would do precious little to alleviate the cost-of-living crisis that is ruining so many lives. It is very clear that the best way to give low and middle income workers a break is by building decent public services. It is done by investing in the health system, delivering social and affordable homes at a level which matches the scale of the housing emergency and ensuring those with disabilities can access proper and dedicated services.

A responsible Government would reject the policies that have led to the decimation of essential services. An irresponsible Government is one that opts to make tax cuts when public services are crumbling and people are suffering. This is not just auction politics but also short-sighted and destructive politics. The Government is so deluded and out of touch that it believes this is its route to electoral success. It is about trying to buy votes. However, the people whom the Government is trying to buy off will not be bought off so cheaply. It has it wrong again. Frankly, it is incredible that tax cuts versus investment in public services is even a matter of debate. The facts on the ground, in communities and our families, should have settled that argument already. The vast majority have had their fill of auction politics. They want and demand decent public services, for which they are crying out. They want children out of hotel rooms and in homes. They want patients off trolleys and waiting lists. They want to have the opportunity to buy their own homes.

Given the limited fiscal space, will the Government make the necessary investment in public services or will it insist on tax cuts that would further decimate the State's ability to respond to these crises? It cannot do both. Choosing tax cuts over investment in public services in the budget will give the clearest evidence yet that the Taoiseach, much like his predecessor, is not serious about tackling the issues which are impacting on the lives of ordinary people.

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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The first thing we want to do is make sure we continue the economic progress the country has seen. In the very first instance we have the capital which is provided by the Government. We have taxpayers who are paying tax and because it has been managed properly, we are now in a position to invest in services, contrary to the position inherited by the previous Government three or four years ago when there was no money available to spend on services.

We have come full circle and are investing again in the services people need. We can do this because we have an economy that is growing and developing and because there is capital to invest. There has been substantial investment by the Government in the development of public services, including health and education services and housing, and that will continue next year. We have prioritised large budgets for the provision of housing and health services. There are many challenges, but we have the capital to invest which was not available previously and we will invest it in a prudent way. We will also balance the books, which is important because we want to be able to continue to substantially increase budgets in the years ahead.

As I said, we will continue to invest wisely in capital projects that are needed in the provision of services; in targeted income supports, as was done in budget 2017, as well as in supporting the vulnerable and increasing the budget substantially for disability and mental health services. We will also continue the process of tax reductions. There would not be money to spend on services if people were not going out to work. It is the people's money that we are spending on all of these services and they also deserve support. As I said, we will continue the process of tax reductions. We will also help businesses and families to plan for the future, which is important.

We will set out our key budgetary objectives and publish a national planning framework and the ten-year capital plan, all of which will give certainty and the people can have confidence that the investment in services will continue. That will be the focus. It will be comprehensive and involve a 4.5% increase in the capital budget for next year which will lead to the investment people want to see in all public services. We will favour expenditure increases over tax reductions by at least a ratio of 2:1 in line with A Programme for a Partnership Government and the confidence and supply arrangement.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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The Tánaiste's reply was most unconvincing. I do not think even she is convinced by the flawed and almost perverse argument she has presented. The people who go out to work and pay their taxes are also the ones who are casualties of the lack of investment in housing and health, child care and many other services. They are not two competing realities. They are one and the same and what they are telling us - I imagine they are also telling members of the Government this, unless they are living in a different or parallel universe - is that they are not prepared to tolerate any longer a position where there are more than 600,000 people on waiting lists for medical procedures; record numbers on hospital trolleys; people are unable to afford to pay their rent and people will never be able to aspire to home ownership. They are the tax paying, working people it seems the Government will insult in the budget with €1 or, if it goes along with its friends in Fianna Fáil, €1.50 a week or a little more according to its plan.

Shane Cassells (Meath West, Fianna Fail)
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Every Sinn Féin councillor plays a part in-----

Mary Lou McDonald (Dublin Central, Sinn Fein)
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Despite the sensitivities of my Fianna Fáil colleagues, I put it to the Tánaiste that it is utterly reckless and irresponsible to talk about tax cuts as a means of rewarding working people.

Shane Cassells (Meath West, Fianna Fail)
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What about Sinn Féin councillors-----

Pat Gallagher (Donegal, Fianna Fail)
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Deputy Mary Lou McDonald must conclude.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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Will the Government drop that proposal and will it recognise and invest in the services on which we rely?

Shane Cassells (Meath West, Fianna Fail)
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The Deputy is talking nonsense.

Pat Gallagher (Donegal, Fianna Fail)
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I might have to give the Deputy a yellow card.

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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In the forthcoming budget we will continue to take the approach that has allowed this country to invest in the kinds of services that clearly need to be developed at this time in our economy. We will have a budget that will be incremental, sustainable and fair because we want to be fair to those people who are working and to the vulnerable, and we want to make sure that we support the kind of job creation we have seen in this country. We all know that the best way out of poverty is to have a job. With the level of job creation we have had, we now have the income to invest in the kinds of services that the country now needs.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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Well then, do that.

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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That is precisely what we will be doing in the budget. It is not about one or the other.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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No, it is about one or the other.

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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It is about supporting our workers and the development of services in this country and, most of all, about creating the kind of economy that can invest. If we do not manage the economy properly, there will not be the money to invest, which is the position this country found itself in a few years ago.

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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Following the retirement of the Garda Commissioner, Nóirín O'Sullivan, the process is under way to appoint her successor. It is primarily the job of the Policing Authority and the Public Appointments Service, PAS, working together to find the best candidate for that job. The Deputy quoted a salary figure, but certainly there is no decision by the Government regarding that figure, regardless of what reports may have indicated in that respect. Clearly, the issue of recruiting the very best candidate is important and the Commission on the Future of Policing in Ireland is also examining the kinds of skills that are needed to run a large-scale, 21st century policing service, and it will be giving the Minister for Justice and Equality its views on that.

The Deputy referred to structured mechanisms. The best structured mechanism recently was the agreement on public sector pay. There is no question of abandoning the structured mechanisms that we have. However, there is an issue with some jobs and there is some flexibility to attract the right candidate, whether that is to run aspects of our health service or other areas. That will always be dealt with in a careful away. I take the Deputy's point about the danger of setting precedents and changing the approach to top level pay in the Civil Service and elsewhere but, clearly, there are recruitment difficulties, about which every Member will be well aware, given the competition for people. More and more we are seeing gaps in services because of the difficulties in recruitment. This issue needs to be considered because we want the very best people to run our services. The Deputy quoted one arena where, clearly, that is very important but there are others as well.

The structured mechanisms are important in terms of the review of top level pay. We have to accept that there are difficulties increasingly in filling some senior management posts. We all want better management, whether it is in health or housing or a range of other areas. This is an issue which the Government will consider carefully in each instance but clearly, there is a broader approach, which the Deputy has outlined, and there is no intention to depart from that.

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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I said clearly but I will reiterate that the Government favours a structured approach to the issue of pay, which we demonstrated again last week in the agreement that was reached. I also said that there are difficulties in recruitment and that, on occasion, these may lead to a decision in specific circumstances where the issue of pay may have to be reconsidered but the overall approach is absolutely one of a system being in place under an agreement that is being implemented in respect of top level pay.

I will have to revert to the Deputy regarding a review of top level pay.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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In the past hour, the media has been reporting that a 41 year old man with ongoing health problems was confirmed to have been found dead. He was homeless and sleeping in a tent with his partner in Bray over the weekend. This is the third rough sleeper found dead in the past number of weeks. I do not know the exact circumstances of this personal, human tragedy for this man and his family but it cannot be anything other than a shameful stain on this State that yet another person was living in a tent ill and was then found dead by his partner.

This has happened time and again in recent weeks against the background of an absolutely shameful housing and homelessness emergency. I ask the Tánaiste to look urgently at the circumstances surrounding how this could possibly have happened. I must also ask her and her Government colleagues to reconsider the decision of the Government to vote against the Bill which proposes that we insert a right to housing into the Constitution. That vote will be taken in a short while. I simply cannot understand it. I listened with dismay to the Taoiseach yesterday afternoon and afterwards the Minister and the Minister of State explain, or, more correctly, fail to explain why the Government would not listen to the Simon Communities of Ireland, the Peter McVerry Trust, the Children's Rights Alliance and all of the non-governmental organisations dealing on the front line with people who find themselves in these tragic positions. They have stated we should insert a right to housing into the Constitution, but the Government plans to bury that proposal which was supported by 84% at the Constitutional Convention in 2014. It wishes to "further consider" the matter, but people cannot even agree on what committee should consider it. The Government indicates that it should be the finance committee; Deputy Barry Cowen has argued that it should be the housing committee, while Deputy Marc MacSharry has indicated that it should be the justice committee. It sounds to me like they want the issue to be buried in any committee instead of agreeing to the proposal and inserting a right to housing into the Constitution. It is shameful. I ask the Tánaiste to seriously reconsider this decision and send a signal from the Dáil today that human beings living in this state have a right to be housed in dignified, affordable accommodation and not be forced into the tragic circumstances in which so many find themselves.

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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I do not have the information sought on the individual mentioned by the Deputy, but the thoughts and sympathy of this House go to that person and his family in what are absolutely tragic circumstances, as noted by the Deputy. It is because we believe people have a right to housing that we are taking the range of actions outlined last night in the House by the Minister, Deputy Eoghan Murphy, with reference to the Bill. The recommendation from the Government is that the matter should be referred to the finance committee for further discussion on the approach to be taken.

Taking the key point about providing housing for individuals, that is clearly what the Government wants to and is determined to do. It is why the budget is what it is, with billions of euro to be allocated in the next few years. It is why the budget to tackle homelessness has doubled since 2014, rightly so. It will be more than €100 million. The Department and the Minister, Deputy Eoghan Murphy, are working very closely with all of the voluntary housing agencies. The vast majority of the recommendations they have made to the Government are being implemented. That is what they will state about the approach taken to dealing with homelessness. They are supplying many of the extra emergency beds which are now available and which will be made available in the next few weeks.

We have also taken the decision to establish family hubs on a short-term basis in order that families and children can be in better accommodation, with more support services to help them than they would have in emergency hotel or hostel accommodation which is seen as a temporary solution until social housing comes on stream. The Deputy knows that there will be over 21,000 new builds next year, of which, as the Taoiseach stated yesterday, a quarter will be social houses. We will also focus on affordable housing, although clearly that will not happen overnight. We will use every resource we possibly can to meet the housing needs of the people. It is a priority on which the Minister is absolutely focused. Every action that can be taken to help people is being taken. That is why 80 people per day are being given a housing solution to meet unmet housing needs. We must remember that that is happening also.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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With every Government announcement and policy change over the past three years, the housing crisis has gotten worse. The number of homeless people and the number of families and children in need of housing have gotten worse rather than better and the tragic deaths of people sleeping rough on the streets continue. Why would a proposal to enshrine the right to housing as a basic human right be referred to the Joint Committee on Finance, Public Expenditure and Reform and Taoiseach three years after the Constitutional Convention said that it should be put in the Constitution? Perhaps the motive was revealed when I asked the Taoiseach yesterday why the Government is not supporting that proposal and he said he did not believe that everyone should be housed for free. What on earth was the Taoiseach talking about? Who is housed for free in this State? Does that statement not reveal a deep-seated prejudice against people who rely on social housing and would pay their rent but cannot get social housing because the State fails to provide it? Is that the real reason the problem is not being solved?

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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The Government is focussing on solutions. A range of new initiatives was announced by the Minister, Deputy Murphy, and the Minister of State, Deputy English, including for example, after their meeting with local authority directors. The Government is taking actions that will make a difference.

There is a suggestion that the Private Members' Bill should go to the Joint Committee on Finance, Public Expenditure and Reform and Taoiseach so that its precise implications can be examined.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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It is three years since the Constitutional Convention recommended the right to housing be enshrined in the Constitution.

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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It is important that the Government invests and ensures that the initiatives it is taking are making a difference for families. That is the focus of the Government and that is what it is doing. There is increasing demand. There is now fast-tracking of planning applications. The builds are increasing and that will continue. We have come from a situation where there was no investment in housing to the stage where this Government, as outlined in Rebuilding Ireland, has committed billions of euro to ensure that the housing needs of people of this country are met now and in the future.