Wednesday, 4 October 2017
Questions on Promised Legislation
There is a lengthy section in the programme for Government on disability objectives and legislation. Focusing on one area, it states:
Personalised budgets provide an individual with more control in accessing services, giving them greater independence and choice. We will devolve budgets to the person so that they may shop beyond traditional service providers to better fit their needs. To do so, we will establish a Taskforce within 3 months on the implementation of personalised budgets for persons with disabilities. Core to this Taskforce will be:- The adoption of a single national coherent application system to develop budgets before end 2017
- The adoption of a single national coherent system of accountability for the spend
- Exploring brokerage models...
- Actively monitoring practice, usage and trends....
We are now in October 2017. Will the Taoiseach update the House on progress in the establishment of the task force and its work, as outlined, all of which is to happen before the end of 2017?
To the best of my knowledge and recollection, the task force has been established and a personalised budgeting scheme has been piloted on a number of occasions. It is a tricky and difficult process because, essentially, it does not just involve giving an individual a personal account which he or she can use to purchase services he or she wants. It means taking money from the service provider who previously received it for the individuals involved.
We had a Cabinet sub-committee meeting specifically dealing with disability matters last week. The task force has already been established and the budget has been piloted-----
Ba mhaith liom ceist a chur ar an Taoiseach faoin mhéid atá i gclár an Rialtais i dtaobh an drugs payment scheme. Tá an clár an-soiléir faoi shaoránaigh mhíchumasacha. The programme for Government is very clear that citizens with disabilities should be supported. Yesterday I attended a briefing in the audiovisual room hosted by Seanadóir Rose Conway-Walsh attended by the parents of three wee boys, William, Cathal and Lewis. We were told the drug Translarna could make a real difference for these children. Five year old Lewis has been eligible for this medication for almost a year but he has not been able to access it as the Health Service Executive is refusing to reimburse the cost. Three year old Cathal, we are told, will lose the use of his legs and may need ventilation to help him breathe, and eventually his heart and lungs will fail.
William faces a similar fate. In keeping with the Government's commitment in the programme for Government, will the Taoiseach instruct the Minister for Health and the HSE to facilitate the availability of Translarna by agreeing to reimburse the cost and giving these lads a chance to fulfil the potential they have?
The Deputy is well aware neither the Taoiseach nor the Government has the authority to instruct the HSE to approve any drug. The way drugs are reimbursed or not reimbursed is set out very clearly in legislation and it is a matter for the HSE to decide which drugs should be reimbursed and which are not. I understand in the case of Translarna, the HSE has come to the conclusion, based on medical and clinical advice, there are limitations to the efficacy of the drug and there is also a very high cost. If something is not very effective and also very expensive, in general the HSE will not fund it.
I am aware that Translarna is available in public health systems in approximately 20 or so other countries. I have sought a bit more information on the decision because, as the Deputy knows, it is often the case that we are among the first countries in the world to approve the use of new medicines. That was the case with Orkambi, for example, which is available here and not in Northern Ireland, for example. That is something I ask Deputy Adams to take up with his MLAs in the North.
I know, and Orkambi is not. That is the point I am making. I could speak on behalf of people with cystic fibrosis in Northern Ireland and implore the Deputy and his party to use his influence to achieve that.
There is a further complication with Translarna with the quite unprecedented position that the pharmaceutical company making the drug has taken the Government to court. That is certainly making a solution much harder to find.
Even somebody as well known, media savvy and dynamic as the Taoiseach could easily have been missed at the massive demonstration for choice that took place in Dublin last Saturday. Among the tens of thousands of people were thousands of young students who were concerned and queried many Deputies there about the timing of the referendum next year and who would like to see it happen during the academic year rather than the proposed date of 8 June mooted by the Taoiseach. The reason is simple as many of them - thousands of students - leave the country as soon as their exams are finished to take up employment. Having campaigned very vigorously for the first time in their lives to have choice over their own bodily autonomy and a say in this important matter, they would be deprived of a vote. The vote on the same-sex marriage referendum took place in May so could the Taoiseach at least commit to doing his best to have the vote when the students are still around rather than when they would exit the country?
No, but as always she was articulate and asked a very pertinent question.
It is very much my preference that the referendum be held in May rather than June in order that we maximise the number who will be able to participate in it. I have met student groups and said this to them. There is an all-party committee which is to make a recommendation to the House on whether there should be a referendum and also on the wording. As almost all of us accept at this stage that there will be a referendum, I look forward to seeing the committee's recommendation on the wording. It will then be up to the Government, or the House, to propose a wording. We will require legislation and a referendum commission, as well as time for a campaign. Based on that process which is the only one we can follow, the earliest we can hold the referendum is May. That is certainly my preference, but it is not something that is fully under my control. Ultimately, the Oireachtas will decide the date of the referendum, not the Government.
Commitments to improve child welfare services are outlined on page 75 of the programme for Government. This morning the organisation One in Four stated it was extremely worried that dangerous offenders might be continuing to abuse children, even though they had been brought to the attention of Tusla. When I raised this matter with the Taoiseach recently, I told him that Tusla had received a truly shocking 70,000 referrals for abuse between 2013 and 2016. Will the Taoiseach, please, ask the Minister responsible to ensure dangerous offenders will be targeted by Tusla and that vulnerable children will have every resource necessary made available to them?
I will. The Deputy will be aware that Tusla was established in 2014 as a dedicated child protection agency. Its budget for this year is €713 million, a 5% increase on its budget for last year. The Minister for Children and Youth Affairs, Deputy Katherine Zappone, is absolutely committed to ensuring and improving child protection in Ireland. The One in Four report states Tusla was unable to proceed with 79 of 91 cases because the alleged victim had declined to meet the Tusla social worker. Legally and in keeping with fair procedures Tusla is obliged to meet the victim directly to validate his or her statement before it can approach the alleged abuser. One in Four reported that 12 of its clients had made a statement to a Tusla social worker. In three of these cases Tusla was assessing whether the alleged abuser posed a risk to children. One case was deemed to be founded; five cases were deemed to be unfounded, while the three remaining cases were closed without an assessment of risk because the person concerned could not be located, perhaps because he or she had left the country or had died. It is important to point out that it is the role of the Garda to investigate historical allegations of crime. Tusla's role is to assess whether there is a current risk to any child. That is what it does.
My colleague, Deputy Billy Kelleher, via a Private Members' Bill in 2013, raised the issue of the need to change legislation to allow for the use of biosimilar products to compete with biological medicines. Ireland is probably bottom of the class in dealing with this issue. There are 28 products available in the European union, of which Ireland only allows the use of 11. We need to change the legislation to allow biosimilar products to compete. We need to take them off the list of medicines which are not interchangeable. Physicians are currently not allowed to interchange. Physician-led interchangeability is also not allowed. One example is a product called Enbrel which is used in the treatment of arthritis. In August 48,000 boxes of Enbrel were dispensed. There is a biosimilar product available called Benepali, of which only 56 boxes were dispensed in the same timeframe. There are huge savings to be made. We discussed the product Translarna this morning and Respreeza yesterday. There are millions of euro to be saved if we act on this issue. A simple change to the legislation would help to bring such savings about. I ask the Taoiseach to activate it immediately to enable us to access the products we currently cannot access.
I am not sure legislation is required in this area. I would have to check that with the Minister for Health. I understand we use some biosimilars but I will ask the Minister for Health to contact the Deputy directly.
I have to raise again the question of orthodontic treatment for young girls especially, or the non-treatment of these girls. I am sure it affects boys as well in the county that I come from. What progress has the Taoiseach or the Minister for Health made with the Health Service Executive, HSE, in finding out why such a delay exists? I have been told there are five types of waiting list: priority, fixed, routine, emergency and a thing called the waiting list initiative, which was last offered in February or March 2016.
This Government is giving millions of euro to the HSE and we are not looking after these vulnerable people. Is the Government going to deal with this or not? If it does not it should forget about it altogether and pull out. It has gone beyond-----
There is funding for waiting list initiatives this year. There is €15 million provided for the National Treatment Purchase Fund, NTPF. Precisely how that is allocated to different procedures is a matter for the HSE and the Minister for Health.
Everyone in this House knows the merits of an independent permanent electoral commission: an increase in voter participation and in voter education, maintaining the electoral register and monitoring campaign finances among many other benefits. Is there an established timeframe for the legislation this will require or for the establishment of this body?
There is no timeframe for it. It is very much a long-term project. In the meantime local authorities will continue to manage the electoral register and the Standards in Public Office Commission, SIPOC, will continue to carry out its role.
The programme for Government makes a commitment to developing and enhancing many rural towns and villages throughout the country. Many of these towns in my constituency, Sligo-Leitrim, are suffering badly as a result of the property-led economic crash and the recession. What proposals does the Government intend to put in place to enhance the towns and villages? Is the Government committed to the three-year plan for the village and town renewal programme?
There is indeed a programme for Government commitment to advance a town and village renewal scheme. Deputy McLoughlin may be interested to know that the Minister for Rural and Community Development, Deputy Ring, and the Ministers of State, Deputies Moran and Kyne, are in Longford announcing €21 million in funding for towns and villages, including 14 projects in County Sligo, including Tubbercurry, Strandhill-----
As a person involved in the planning process I wish to put on the record what could be perceived as a conflict of interest. With regard to the content of the programme for Government on tackling the housing crisis, how much longer must people wait to see the changes in regulations and the planning process that this Government is going to bring forward to help people trying to get and provide accommodation, who find obstacles and red tape in their way? When will the Government act on this and how much longer will people have to wait? There has been report after report-----
I understand the Minister, Deputy Eoghan Murphy, will announce changes to some of the planning regulations within the next ten days. The Deputy will also be aware of Deputy Barry Cowen's Bill which is before the House and which the Government is supporting which has been designed to make it easier for people to bring vacant units into residential use. The Deputy will also be pleased to know that County Kerry benefits from what has been announced to date to the tune of €868,000, which includes funding of over €64,000 for Killorglin.
In the programme for Government the Government outlines that its approach to governing will be seem clearly in how it addresses the issues of housing and homelessness. It goes on to state it will be expediting significantly the delivery of social housing. In 2014, when I was a councillor, South Dublin County Council initiated a Part 8 process in Rathfarnham in my constituency for 38 social houses. Of 40 councillors, 39 supported this process. Deputy Alan Kelly was Minister for Housing, Planning, Community and Local Government at the time. When the Part 8 process was approved in November 2015, Deputy Simon Coveney was Minister. Two years later, despite councillors' approval and much community support, the sod has yet to be turned on the site and now Deputy Eoghan Murphy is Minister for Housing, Planning and Local Government. As I know that the delay is not on the council's side, what do I say to 38 of the 10,000 people on South Dublin County Council's housing list? How has the Government expedited the delivery of social housing?
I do not know the reason for the delay in the particular project. I will ask the Minster, Deputy Eoghan Murphy, to contact the Deputy about the matter. On the provision and funding of social housing, someone suggested we use the term "public housing" which I agree would be a better term than social housing. We have gone from the construction of only a few hundred units two years ago to over 2,000 this year.
The figure will increase to 3,500 next year. The number of planning permissions has increased by 49% year on year. The number of commencement notices has increased by 47%, while the number of active residential sites in Dublin has increased by 18%.
The report of the expert panel on defective blocks was presented to the Government and published in June. It deals with up to 5,000 homes in County Donegal which are affected by defective blocks because of their mica content. A small number of homes in County Mayo are similarly affected. The report notes that remediation works will be required in order to address the problem. Has the Cabinet had an opportunity to discuss the report? Why has there not yet been a commitment from the Government to establish a remediation scheme in order that the 5,000 families waiting for an answer from the Government can have some stability and hope returned to them that their homes will be fixed?
This refers to the pyrite and mica issue. The matter is being dealt with by the Minister for Housing, Planning and Local Government. It has not yet come before the Cabinet, but we will give the people affected an answer when we have one.
On page 38 of the programme for Government there is a commitment to secure the future of the post office network. At a meeting in Kilkenny in May most postmasters told me that nothing had been done, despite all of the Government's talk and promises. Yesterday the Irish Postmasters Union refuted plans proposed by An Post for future contracts between the two. It argues that most post offices are being closed by stealth and that when postmasters and postmistresses retire, An Post tries to close their former post offices. The Government is standing idly by, although we have been promised plans by the Minister. I believe he is due to meet the Irish Postmasters Union tomorrow. What is the Government going to do to save post offices not only in rural Ireland but everywhere?
The Government is very aware of the importance of the post office network around the country and the value that people attach to it in their communities. It is important to point out the number of post offices closed between 2002 and 2011 during the last Fianna Fáil Government was 700. However, in the past five or six years, notwithstanding the economic downturn, the number of post offices that closed was 40. Ultimately, when post offices do close it is because they become commercially non-viable and it is no longer possible to find a postmaster to run them. I am very much of the view that we should not judge the success of rural Ireland based on the number of post offices. People in rural areas, just as is the case in urban areas, use post offices less and less because more people are at work and more people have broadband and tend to do things online. If we judge the success of rural Ireland it should not be based on the number of post offices, it should be based on the number of jobs, the population, the quality of infrastructure, schools and all of these factors.
Page 60 of the programme for Government speaks about improving waiting times, and along the same lines as our Leader on Leaders' Questions earlier dealing with people with disabilities and other treatments, juvenile arthritis is a major crisis in this country. It might not affect every family, but it affects members of my family and it certainly affects families in every constituency. Young children in chronic pain are on waiting lists for up to two years. At present, we have the equivalent of two and a half paediatric rheumatologists available to treat these children. International best practice states we need to have in the order of six. Despite numerous meetings by lobby groups and organisations on behalf of the parents and many Deputies here raising the issue, it seems the word around the campfire in the HSE is that the cupboard is bare and no money will be available for additional paediatric rheumatologists. I appeal to the Taoiseach to include this in the forthcoming budget because not to treat these children will ultimately be counter-productive because it will cost the State more as these children's treatments become more complicated as their condition worsens.
The word around the campfire in the HSE is always that the cupboard is bare yet the facts say otherwise. We have the biggest health budget in the history of the State.
We have the biggest health budget in the history of the State and it will rise again next year. It will not be long before we are in the top two or three in the world in terms of spending per capita. We need to move the debate on from how much money we spend to how it is being spent and what difference it is making for patients. We have a couple of hundred more consultants now than there were a number of years ago. I cannot say specifically whether consultants will be recruited in that area-----
I wonder whether the Taoiseach is aware of what appears to be a low-level industrial dispute in Bus Éireann at present, which is causing significant difficulty to my constituents in east Meath. I understand it is also causing difficulty in north Kildare and along the eastern region.
This is causing huge difficulty and I wonder whether the Government will get involved. Bus Éireann is making allegations about drivers. The drivers are denying them and all the while many bus users are being completely inconvenienced. The Government needs to get a grip on Bus Éireann and get it to do what is necessary or, as some constituents are pointing out, perhaps ask Dublin Bus to service some of the routes particularly close to Dublin, because there are huge difficulties at present and people are being left completely stranded, particularly students who cannot use the private bus services going directly into town or use them at different times of the day.
I understand this relates to a dispute over the introduction of new rosters in Bus Éireann. As it is an industrial relations matter it is of course a matter to be handled between the unions and the company.
The health insurance (amendment) Bill is promised legislation. It relates to the risk equalisation credits and corresponding stamp duty levies on health insurance policies for 2018 to incorporate the lifetime community rating system, and will have an impact on public health insurance. When is the Bill likely to come before the House?
The Bill was approved by Cabinet this week, so it will come before the House and will be enacted, or it is intended it will be enacted, through both Houses before the end of the year, as it has to be. As the Deputy mentioned health insurance, I certainly welcome the news this morning that VHI, the biggest health insurance company, is going to reduce its premiums across a number of plans.
That will be welcome news for people across the country because it is the first time we have seen health insurance premiums go down in a very long time.
In the programme for Government, in which the Taoiseach was involved, there is a commitment to a review of the air ambulance service across the country in light of very slow response times in some areas, especially the west. The Government is halfway through the term of its confidence and supply agreement. Will it be at the end of that term or at another stage that the Government will honour this commitment? Is there any commitment at all?
If I recall correctly, that commitment is in the programme for Government, not the confidence and supply agreement. We are only about 20% of the way through the commitments of our programme for Government, which runs for five years. I do not believe the review has started yet but we will certainly do it. I had the experience of spending a few hours travelling with the air ambulance service as Minister for Health. It is a service that saves lives because it gets people to the right hospital quickly, particularly if there is major trauma, a heart attack or another condition requiring a certain form of treatment. It is something we are very committed to extending in the years ahead.
I want to ask the Taoiseach about the commitment on page 83 of the programme for Government, which states, "We will introduce a uniform homecare service so all recipients can receive a quality support, 7 days per week". The Taoiseach will be aware that there is no more quality or uniformity in the home care service than there was when the document was written back in February 2016. Seven days per week is a joke; even seven hours per week would be an exaggeration. The service has ground to a halt in Limerick. When will we reach the nirvana set out on page 83 of the programme for Government?
There is public consultation under way - the Deputy is one of the people who led on this and helped to instigate it - on moving to a whole new system of home care, something similar to the fair deal scheme. We are keen to progress that as soon as possible.
While the Minister for Housing, Planning and Local Government is constantly developing strategies for the delivery of housing for social housing applicants, an issue arises. Local authorities have been directed to purchase houses at all prices. When will the Taoiseach direct the local authorities to focus on building? I have seen cases where private individuals were outbid by the local authority. I have been assured by some of those individuals that if they went to the bank to ask for a larger mortgage to outbid the council, the bank would not agree to give them a loan for the purchase of the house. The local authorities have an open cheque. Does the Taoiseach believe this represents value for money? When will he be in a position to direct the local authorities to build as opposed to buying houses in tranquil, settled estates that have already complied with Part 5? There are issues arising. When can we see a change of emphasis from building to buying?
There is no legislation but the Minister, Deputy Eoghan Murphy, announced a few weeks ago at the housing summit at the Customs House a policy change to do exactly as outlined. Instead of purchasing houses, local authorities have been asked to build them. Eight hundred houses that were to be purchased next year will now be built by local authorities instead. That is not to say the local authorities will never buy houses in private estates again. Sometimes it is appropriate that they do so, to ensure there is a social mix and particularly if a house is derelict or has been abandoned. Louth County Council, in particular, has been very progressive in using its CPO powers to purchase private houses and turn them into public housing. In general, however, the policy shift is away from local authorities bidding against young couples trying to buy a house in favour of building them instead. That announcement was made by the Minister, Deputy Eoghan Murphy, at the Customs House a couple of weeks ago.