Dáil debates

Tuesday, 16 January 2018

2:00 pm

Photo of Micheál MartinMicheál Martin (Leader of the Opposition; Cork South Central, Fianna Fail)
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Over the recent period, the number of patients on trolleys in our accident and emergency departments has broken all records and fairly and objectively represents a damning indictment of the Government's lack of planning in respect of this crisis, its lack of urgency, its lack of prioritisation of a phenomenon that has caused significant distress to many patients and families throughout the country, and much more. The Irish Association for Emergency Medicine reasonably asked how many more patients would have to die needlessly while inertia prevailed. This is in a context in which it is estimated that 350 to 400 deaths per year are directly attributable to emergency department overcrowding.

This situation is interesting, given what happens in Scotland and England. In Scotland, just 6% of patients waited for longer than four hours. In Ireland, 19% of patients waited for longer than nine hours, which is a considerable difference. In England, commentators describe people waiting longer than four hours as a shocking lapse. Ms Susan Mitchell recently put it well in her article in the Sunday Business Post, which stated: "What passes for inexcusable in Britain would represent a huge improvement for the Irish health system."

Three years ago, the Taoiseach as Minister for Health said that he was "sick to death" of the problem and that he would solve it once and for all. He referenced a long-term plan to solve it. Three years on and that plan has never materialised.

As we know, the situation has become much worse since that announcement by the Taoiseach. This reflects a continuing unacceptable approach, a fundamental lack of urgency in respect of this issue and, sometimes, an attempt to normalise it. The toleration threshold relating to people waiting in accident and emergency departments is simply unacceptable and too high. The level of complacency is shocking.

In terms of some of the Government's own metrics and targets, the capital provision is woefully inadequate and does not provide for any meaningful response to the awaited bed capacity review. On the GP contract talks, we have been told for the past two or three years that something would materialise but it has not. Nothing is happening. Community intervention teams have not been established and providing diagnostics in the community is another aspiration. There is a lack of home support and so on and the crisis is all round. The budget is passed in October and the HSE's service plan is published in late December. There is an absence of transparency in the lead up to the budget. The Government takes it on trust that adequate provision will be made for acute services but that never materialises.

Does the Taoiseach accept that the Government did not adequately prepare for the current crisis and that this is why there were record numbers on trolleys, which caused enormous distress to people throughout the country? Will he confirm that real, meaningful funding will be provided to underpin the recommendations of the bed capacity review in terms of extra beds in 2018?

2:05 pm

Photo of Leo VaradkarLeo Varadkar (Taoiseach, Department of An Taoiseach; Dublin West, Fine Gael)
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I would like to start by welcoming everyone back to the House after the December and January recess. I also want to begin by paying tribute to Dolores O'Riordan who died yesterday. For so many of us, especially those of us who grew up in the 1990s, she was the voice of a generation. No matter where one was in the world in recent times, it would not be long before one heard a Cranberries song on the radio, even in the most far-flung places. Dolores blazed a trail across the world with her unique voice and song-writing talent. Our thoughts are with her children, family, friends and the people of Limerick in particular. Guth glúine ab ea Dolores O'Riordan. Beidh a hoidhreacht ceoil linn go deo. Go ndéana Dia trócaire ar a hanam.

Regarding hospital overcrowding, which was raised by the leader of the Opposition just now, according to the HSE, 415 patients were on trolleys in emergency departments and on wards this morning. We expect that number to fall throughout the day, as it usually does, to approximately 250. It is important to say that two thirds of people who attend an emergency department are through it within nine hours. In other words, from the time that he or she registers, a patient is either in a hospital bed or discharged home within nine hours. That is the experience for two thirds of patients but, of course, the experience for many others is much worse and can sometimes involve prolonged periods spent in emergency departments or on trolleys while waiting for beds. That is something I do not seek to defend in the House today because it is not defensible.

If this was simply a matter of political will or finance, we would have resolved this problem a long time ago. Indeed, in 2006, Deputy Micheál Martin was a member of the Government which declared this a national emergency. The Deputy's party was in government for a further five years after that. That was-----

Photo of Thomas ByrneThomas Byrne (Meath East, Fianna Fail)
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The Taoiseach served as Minister of Health in the intervening period.

Photo of Dara CallearyDara Calleary (Mayo, Fianna Fail)
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What is this Government's plan?

(Interruptions).

Photo of Leo VaradkarLeo Varadkar (Taoiseach, Department of An Taoiseach; Dublin West, Fine Gael)
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If it was simply a matter of political will on the part of any party or of providing Government funding, the matter would have been resolved by now. That is particularly obvious when one considers that there has been an almost 20% increase in health funding in the past three years. The population has increased and there are now more older people here. There has also been pay restoration but certainly not in the region of 20%. Depending on whose figures one accepts, funding for our health service puts Ireland in the top six or top three in the world on a per-capitabasis. As a doctor who worked for seven years in our health service, including in emergency departments, as a former Minister for Health, as a politician who represents tens of thousands of constituents and as somebody who has elderly relatives who, on occasion, have had to spend time on hospital trolleys, I can say that the Government is doing everything it can to alleviate both the short-term and longer-term issues involved. I do not want any citizen to face the indignity or the clinical risk that comes with a prolonged stay on a hospital trolley.

In terms of what is being done, the Cabinet discussed this matter in detail last week. We are going to continue to press ahead with increasing our hospital bed capacity - increasing the number of acute beds in our system.

That is under way already. Almost 200 new beds have come into the system in the last year. The number of beds in the system increased in the previous year as well. The Minister for Health will bring the bed capacity review to the Cabinet before the end of the week. We have approved the resumption of talks with GPs on a new contract. Obviously, it takes two to tango. We are very keen to have the new contract agreed this year in order that implementation can begin. The position of director of health service reform, as head of the Sláintecare office, was advertised on Friday. I hope we get good applicants for that position.

We want a particular focus on mainstreaming best practice across our health service because there are huge variations. Hospitals like Beaumont Hospital, St. Vincent's University Hospital, Connolly Hospital, Cavan General Hospital and Our Lady of Lourdes Hospital in Drogheda have seen considerable reductions in hospital overcrowding. Interestingly, figures from the Irish Nurses and Midwives Organisation for the eastern region show that last year, overcrowding across the hospitals in Dublin and Naas was at its lowest level since records began, even though there has been a big increase in population and in ageing in that region. There are huge variations across hospitals. I suggest that in the future, we should place a greater focus on mainstreaming best practice where it occurs in the health service, as it often does. We need to make sure best practice is mainstreamed. We need to ensure additional resources are put into rewarding good performance and best practice. We should not always put more resources into systems that do not work.

2:15 pm

Photo of Micheál MartinMicheál Martin (Leader of the Opposition; Cork South Central, Fianna Fail)
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On a point of order, I would like an opportunity on the Order of Business to pay tribute to Dolores O'Riordan. I thought that was the opportunity we were going to be afforded.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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Yes.

Photo of Micheál MartinMicheál Martin (Leader of the Opposition; Cork South Central, Fianna Fail)
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I was Minister for Health from 2000 to 2004. Some 1,600 extra beds were provided between 2000 and 2005. That occurred under my watch. Contrary to what the Minister, Deputy Harris, has been saying on the radio, there was massive investment in acute hospitals at that time. I will leave that to one side because people are interested in the issues we are facing here and now.

I will explain why I have said there is a lack of urgency. Last summer, Letterkenny University Hospital made a submission to the HSE and the Government for an extra 20 beds at a cost of €1.8 million. It did this last summer so that it would be ready for Christmas and the winter initiative. It did not receive a reply. Deputy McConalogue raised the matter with the Taoiseach and the Minister, Deputy Harris, and as a topical issue, but no action was taken. As a result, there are 36 people waiting on trolleys at the hospital for admission today. Last week, Letterkenny University Hospital had the unenviable claim of having the highest number of people on trolleys - 45 - which is an illustration of how chronic this issue is. I understand there were 2,000 people on trolleys at the hospital in 2016. According to Deputy McConalogue, that figure increased to 5,000 in 2017. The hospital had a solution and it made a submission, but it did not receive a response. When Deputy Kelleher raised this matter at the health committee some months ago, he was assured that things would be looked after and that we would not have record numbers of people on trolleys. We are beating those records every year.

The Taoiseach and his Fine Gael colleagues have been in government for seven years. It is about time they took responsibility for their time in government in respect of issues like this. The failure to respond to cases like Letterkenny resulted in the exacerbated crisis we witnessed this Christmas. There are other examples across the country of submissions being made to the Minister in plenty of time. Hospitals sought funding to try to alleviate the worst of the crisis but they simply were not responded to. The Taoiseach and the Minister, Deputy Harris, were alerted to the Letterkenny submission but there was no response to it.

Photo of Leo VaradkarLeo Varadkar (Taoiseach, Department of An Taoiseach; Dublin West, Fine Gael)
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Funding for Letterkenny University Hospital has increased from €94 million five years ago to €121 million this year.

Photo of Micheál MartinMicheál Martin (Leader of the Opposition; Cork South Central, Fianna Fail)
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I am talking about capital provision for beds.

Photo of Leo VaradkarLeo Varadkar (Taoiseach, Department of An Taoiseach; Dublin West, Fine Gael)
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Its budget has increased by almost €30 million.

Photo of Charlie McConalogueCharlie McConalogue (Donegal, Fianna Fail)
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What about the 20 beds and the 36 people on trolleys today?

Photo of Leo VaradkarLeo Varadkar (Taoiseach, Department of An Taoiseach; Dublin West, Fine Gael)
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We need to have a health service in which such a level of increase in funding and investment results in better outcomes for patients.

Photo of Micheál MartinMicheál Martin (Leader of the Opposition; Cork South Central, Fianna Fail)
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That is not the issue.

Photo of Leo VaradkarLeo Varadkar (Taoiseach, Department of An Taoiseach; Dublin West, Fine Gael)
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If that does not happen, we will continue to do more of the same.

Photo of Thomas ByrneThomas Byrne (Meath East, Fianna Fail)
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Is that a threat to close wards?

Photo of Leo VaradkarLeo Varadkar (Taoiseach, Department of An Taoiseach; Dublin West, Fine Gael)
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We know that more of the same does not work.

Photo of Timmy DooleyTimmy Dooley (Clare, Fianna Fail)
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The Government controls the HSE. It should have got rid of the board.

Photo of Leo VaradkarLeo Varadkar (Taoiseach, Department of An Taoiseach; Dublin West, Fine Gael)
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I did not bring up the fact that Deputy Martin is a former Minister for Health. I brought up a different fact, which I think is important. I mentioned a decision that was taken. It is important for us to double back a bit when we analyse these issues. In 2007, it was decided to start reducing our hospital bed stock. That decision was not made at the time because we were short of money. It was made during the boom.

Photo of Micheál MartinMicheál Martin (Leader of the Opposition; Cork South Central, Fianna Fail)
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That is not true.

Photo of Leo VaradkarLeo Varadkar (Taoiseach, Department of An Taoiseach; Dublin West, Fine Gael)
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From 2007 onwards, the number of acute beds was reduced.

Photo of Micheál MartinMicheál Martin (Leader of the Opposition; Cork South Central, Fianna Fail)
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No. The Taoiseach is wrong.

Photo of Leo VaradkarLeo Varadkar (Taoiseach, Department of An Taoiseach; Dublin West, Fine Gael)
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Fianna Fáil, the Progressive Democrats and the Green Party made an ideological decision-----

Photo of Micheál MartinMicheál Martin (Leader of the Opposition; Cork South Central, Fianna Fail)
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That is factually incorrect.

Photo of Leo VaradkarLeo Varadkar (Taoiseach, Department of An Taoiseach; Dublin West, Fine Gael)
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It is not factually incorrect.

Photo of Micheál MartinMicheál Martin (Leader of the Opposition; Cork South Central, Fianna Fail)
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I have the figures.

2:25 pm

Photo of Leo VaradkarLeo Varadkar (Taoiseach, Department of An Taoiseach; Dublin West, Fine Gael)
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If Deputy Micheál Martin wants to see the figures, they are available in the key trends in health document published by the Department at the end of each year. From 2007 onwards, the number of acute hospital beds was reduced every year. In 2015, however, as Minister for Health, I took the decision to reverse that trend and started to increase the number of acute hospital beds again. The figure increased in 2016 and 2017 and additional beds will be provided this year in Beaumont Hospital, St. James's Hospital, St. Luke's Hospital, Kilkenny, Drogheda hospital, Limerick hospital and Galway hospital, with a modular build under way at Clonmel hospital. It is not the case that this is a simple matter. Where we have put more beds into the system, it has not always resulted in reduced overcrowding, yet significant changes to practices have made a big difference in other places. The Government will do all it can in the short to medium term to alleviate the problem.

Photo of Gerry AdamsGerry Adams (Louth, Sinn Fein)
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Aontaím leis an Taoiseach i dtaca lena fhocail comhbhróin faoi bhás Dolores O'Riordan. Tá ár smaointí lena teaghlach agus a cairde ag an am brónach seo.

On the questions put by the leader of Fianna Fáil, perhaps Deputy Micheál Martin will support Sinn Féin's Private Members' motion this evening on the trolley crisis.

I return to the issue of the absence of adequate respite care services for children living with a disability. The Taoiseach has often said he welcomes constructive proposals from the Opposition. On 6 December last year, when I put to him a modest, costed proposal to increase respite care services, he committed to examine it. I also sent him a detailed copy of my proposal in writing, but he has yet to respond to me. One week after I made my proposal, the Minister of State at the Department of Health, Deputy Finian McGrath, announced that he had secured an additional €10 million for respite care services. As I told the Taoiseach many times, there are no emergency services and only a limited number of respite care beds in my constituency of Louth. While the Minister of State's announcement was presented in part as an urgent response to this issue, it has since emerged that the additional funding is grossly inadequate and a task force to examine the matter has not yet met. In most cases, this involves citizens in a family setting. However, it has emerged that children with a disability who are in the care of the State are being denied respite care facilities.

An investigation by the Ombudsman for Children, Dr. Niall Muldoon, has found that the State has been denying the necessary supports to a woman who has been fostering for 14 years Molly, a teenager with Down's syndrome and severe autism. Molly's carer accused the Health Service Executive and Tusla of abandoning her and leaving her financially, emotionally and physically drained. The Ombudsman for Children found the HSE had abdicated its responsibility to Molly's foster mother by refusing to fund respite care for her. As I am sure the Taoiseach knows, this has caused horrific stress. The report of the Ombudsman for Children is damning. It found that the State's actions had a negative effect on Molly who did not have the opportunity to reach her full potential and that the actions of the State were contrary to fair and sound practice. There are 472 children, including Molly, with disabilities in the care of the State. Among his recommendations, the Ombudsman for Children calls for a respite care action plan for children with a disability in the care of the State and the community at large. While these recommendations have been accepted by the HSE and Tusla, the former has pointed out that its commitment in this area is ultimately resource dependent, in other words, it is now over to the Taoiseach.

This is not another shameful, historical episode of neglect or ill treatment of children in the care of the State. It is occurring now and we will not be able to blame anybody else if it continues because it is taking place on our watch. Does the Taoiseach accept that the report is damning? Does he accept its recommendations and will he provide the resources needed?

Photo of Leo VaradkarLeo Varadkar (Taoiseach, Department of An Taoiseach; Dublin West, Fine Gael)
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The Government decided this morning that we would not oppose the Sinn Féin motion on hospital overcrowding. We want to be in solutions mode and will discuss solutions. For this reason, we will table an amendment, but will not oppose the motion. We hope the debate on the matter this week will be solutions-focused, something I believe we all want.

The proposal Deputy Gerry Adams made to me before Christmas did not add up because, as he knows, Sinn Féin's alternative budget proposed a smaller increase in funding for health and disability services than we had allocated. We responded in kind, which is more important, by providing an extra €10 million for respite care services in the year ahead.

Later this year we will also provide a statutory right for all those in receipt of carer's allowance to see their general practitioner for free. This comes on top of our decision last year to provide all children with a severe disability with a full medical card as a statutory right for the first time.

I was asked about the report on the case of Molly. Tusla and the HSE accept the Ombudsman for Children's report in full and are committed to implementing its recommendations. I know that the Minister of State at the Department of Health, Deputy Finian McGrath, with whom I discussed the matter this morning and the Minister for Children and Youth Affairs, Deputy Katherine Zappone, take the findings very seriously. The investigation highlights a gap in the provision and co-ordination of supports and services by Tusla and the HSE for children in foster care with a diagnosed moderate or severe disability. We all respect and value the role of foster carers, particularly foster parents who take on children with special needs, additional needs or disabilities. The report published by the Ombudsman for Children on the complaint which was made in 2014 by a foster carer on behalf of her foster daughter is of real concern to the Government. Action is already under way, including a review of the supports available to Molly and monitoring her care to ensure her needs will be met into the future. Furthermore, Tusla and the HSE are reviewing all similar cases of children with moderate or severe disabilities who are in foster care with a view to maximising the level of co-ordination, co-operation and support. There must be many other Mollys and we want to ensure the State agencies will review all similar cases.

We must continue to support foster carers who, like Molly's family, have opened their homes to children who cannot live with their own families. As I mentioned prior to Christmas, we provided an additional €10 million for respite care services to support people with disabilities throughout the State and their carers. A joint working protocol has been agreed between Tusla and the HSE. It has been in place since last year and is to ensure Tusla and the HSE will work more closely together. However, it only came into effect on 1 January this year, only a number of days ago. Both agencies are absolutely committed to ongoing implementation of the protocol throughout the country.

2:35 pm

Photo of Gerry AdamsGerry Adams (Louth, Sinn Fein)
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I am disappointed with the Taoiseach's answer. Will he send me a detailed considered response in writing to the written proposal I put to him? I will respond to it at that time.

It is welcome that the Taoiseach is saying he will not oppose our Private Members' motion. Ná habair é, déan é. He should not simply talk about it but act on the recommendations we are putting forward.

The Taoiseach says Ministers are taking the report mentioned seriously. That is an understatement. It is a damning report that indicts the State and its agencies for the way it has treated the child in question and her foster mother. I am calling on the Taoiseach to act on the report and provide resources. He did not answer that point. Those involved in the HSE say they are dependent on the resources they are receiving.

The Taoiseach should know that workers in section 39 agencies are balloting on industrial action because they are being denied pay restoration. He needs to give these workers their entitlements, otherwise, added to all of the other problems, the strike will go ahead and the crisis will be compounded.

This is all about rights. Children with disabilities, whether those being cared for by carers in the community or in the care of the State, have rights. The State is actively denying them their rights and I am asking the Taoiseach to correct the position.

Photo of Leo VaradkarLeo Varadkar (Taoiseach, Department of An Taoiseach; Dublin West, Fine Gael)
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We are providing additional resources all the time for the health service and people with disabilities. Obviously, we need to establish what additional resources may be required to implement the report in full and apply it to other similar cases. Certainly that is what we intend to do. Sometimes, even when we provide financial resources, we can have difficulty in finding staff. That is something on which we will continue to work and improve. I will offer one small example in the provision of special needs assistants. There are now approximately 14,000 in the State. We have more special needs assistants than gardaí or doctors. Some seven or eight years ago that would not have been the case. It is one small example of the Government meeting its commitment to provide people with disabilities with the opportunity they deserve to be equal citizens of the State.

I have discussed the matter of section 39 agencies before with Deputy Gerry Adams. I have answered in the House the question of how we intend to proceed in dealing with it.

2:45 pm

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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I would like to associate myself and the Labour Party with the expressions of sympathy for the family and friends of Dolores O'Riordan, and the people of Limerick, on her sudden and tragic passing.

The past two weeks have been dominated by what is now an annual crisis in accident and emergency departments. It is a sad reflection on our society that news of hundreds of sick people on trolleys is no longer shocking. According to the Irish Nurses and Midwives Organisation, INMO, there are 541 people on trolleys, 413 in emergency departments and a further 128 on wards today. Last year almost 100,000 people spent at least one night on a trolley. That is a shocking number. Our hospitals are operating at an occupancy rate of 95%, which is well above international safe levels.

The Government has almost perfected the management of the news cycle as this annual crisis erupts. There are many myths about the trolley crisis and many proposed solutions. I think the Taoiseach will agree with me that it is important that we do not talk down our health service. There are real problems that we need to resolve. Immense work is being done every day and every night in our hospitals treating sick people. Our population is growing. It is ageing and health problems have become more complex. Diseases that once killed are now being managed and new solutions are being provided to manage complicated illnesses. Progress is being made. Our health service staff are national heroes who save lives every day and we have much to be proud of but we must address the problems.

The Government has perfected the line that it is not a matter of money or resources and we heard that again today. At the heart of the trolley crisis is a lack of capacity and staff and to solve that requires money. Government makes choices and its choice in the last budget was to provide tax cuts rather than to move every cent we had into addressing the crises we face. We should have almost 4,000 consultants but we have fewer than 3,000. Everybody is in agreement that we also need more acute hospital beds. A bed capacity review is still awaited but the number of beds needed has been estimated from up to 9,000, or at a minimum 2,500, over the next ten years if the Sláintecare project agreed in this House is to be implemented.

What is the Taoiseach's plan and what is the actual target to hire more doctors in the coming 12 months? Is the Government going to close the accident and emergency department in Portlaoise hospital and reduce accident and emergency capacity further? How many extra acute beds will the Government put in place this year and each year up to 2021?

Photo of Leo VaradkarLeo Varadkar (Taoiseach, Department of An Taoiseach; Dublin West, Fine Gael)
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I am still shocked by the overcrowding in our hospitals. I am also shocked that it has taken and is taking so long to resolve it. The figure of 100,000 the Deputy gives does not refer to people who spent the night on a trolley. That is a count done at 8 a.m. and could include people on a trolley for fewer than nine hours, maybe even one hour or two hours. The figures collated by the INMO by its own explanation, on its website, include patients who are not on trolleys but are in the wrong sort of bed in, for example, an overflow ward or a unit that should have 12 beds but now has 14 and so on. As more categories of patients are added to that count inevitably the number will go up. That is how these things work.

I very much agree with what the Deputy said, there are many good things happening in our health service and we should recognise them. Life expectancy in Ireland is improving, we are living longer than ever before. That is because of improved public health and a better health service. Irish people when asked about their health rate it as being better than in any other country in the western world. Death rates from cancer, cardiovascular disease and stroke are falling. Those are real positives too and would not be happening if we did not have a well-functioning health service at least in some parts.

Photo of Micheál MartinMicheál Martin (Leader of the Opposition; Cork South Central, Fianna Fail)
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Good long-term strategies.

Photo of Leo VaradkarLeo Varadkar (Taoiseach, Department of An Taoiseach; Dublin West, Fine Gael)
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In respect of patient experience surveys, when 14,000 Irish patients were asked what they thought of their experience in the health service, never mind what we think, 85% said they had a good or very good experience of our health service.

That does not diminish for one second the fact that some patients have a very bad experience of the health service. That is something we need to change.

In pressing ahead, yes, there will be more beds.

2:50 pm

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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How many?

Photo of Leo VaradkarLeo Varadkar (Taoiseach, Department of An Taoiseach; Dublin West, Fine Gael)
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There will also be more staff and money. The increase in the number of beds is happening. I think the figure for this year is 190 additional beds. We do not yet have a figure for next year, but we are working on it as part of the capital plan. There will be more beds this year, as there were last year and the year before. To give the Deputy the figures - in 2017 the number of inpatient beds was 12,123. By 2011 it had been cut to 10,849.

Photo of Micheál MartinMicheál Martin (Leader of the Opposition; Cork South Central, Fianna Fail)
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The Taoiseach should go before and beyond that year.

Photo of Leo VaradkarLeo Varadkar (Taoiseach, Department of An Taoiseach; Dublin West, Fine Gael)
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More than 1,200 inpatient beds were taken out of the system by previous Governments-----

Photo of Micheál MartinMicheál Martin (Leader of the Opposition; Cork South Central, Fianna Fail)
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The Taoiseach is incredible.

Photo of Leo VaradkarLeo Varadkar (Taoiseach, Department of An Taoiseach; Dublin West, Fine Gael)
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-----which involved Fianna Fáil, the Progressive Democrats and the Green Party.

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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Why did Fianna Fáil let them do it?

Photo of Leo VaradkarLeo Varadkar (Taoiseach, Department of An Taoiseach; Dublin West, Fine Gael)
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We are reversing that trend.

Photo of Micheál MartinMicheál Martin (Leader of the Opposition; Cork South Central, Fianna Fail)
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This is a disgrace.

Photo of Leo VaradkarLeo Varadkar (Taoiseach, Department of An Taoiseach; Dublin West, Fine Gael)
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We have more staff in the health service. I think the number is now 110,000, up by 10,000 on the figure five years ago. Notwithstanding the problems we are having in recruitment, we now have nearly 10,000 doctors working in the public health service and more consultants than ever before.

Photo of Timmy DooleyTimmy Dooley (Clare, Fianna Fail)
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The central spin office is paying off.

Photo of Leo VaradkarLeo Varadkar (Taoiseach, Department of An Taoiseach; Dublin West, Fine Gael)
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The figure will increase. We have about 1,500 or 2,000 more nurses than we had two years ago. Therefore, there are more beds and staff. There is also more money and there will be more beds, staff and money.

Photo of Timmy DooleyTimmy Dooley (Clare, Fianna Fail)
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There are more patients on trolleys. What is this about? What is missing?

Photo of Leo VaradkarLeo Varadkar (Taoiseach, Department of An Taoiseach; Dublin West, Fine Gael)
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The point the Government and I continuously make is not that we do not need more resources but that more resources on their own are clearly not enough. Increased resources have not produced the results we want.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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There is a report in today's edition of The Irish Timesthat emergency care services may be removed from hospitals in the Dublin-Midlands hospital group. I have a simple question to ask. Is that true? On the specific questions I asked, does the Taoiseach accept that there is a need for between 2,500 and 9,000 more beds? Providing 190 additional beds in the coming 12 months will go nowhere near addressing the issues. Will the Taoiseach answer the question as to what he thinks is the correct number of consultants who need to be recruited in the next 12 months?

Photo of Leo VaradkarLeo Varadkar (Taoiseach, Department of An Taoiseach; Dublin West, Fine Gael)
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We do not have any plan to close any emergency department in the State, not least because to do so properly, one would need to make sure patients would be adequately provided for in the next centre, the new hospital or the adjoining hospital and that they would have the capacity to deal with the additional workload. We saw the difficulties faced by St. Vincent's University Hospital when St. Columcille's Hospital had its emergency department closed. We also saw the difficulties in Limerick arising from the closures in Ennis and Nenagh. It is not that it was the wrong thing to do. Clinically, it was the right thing to do. However, one needs to make sure the new central hospitals have adequate capacity to deal with the additional patient loads and evidently they do not. That is something we need to take into account.

The bed capacity review indicates that, with reform, we will need 2,500 additional inpatient beds by 2031. As I have no reason to dispute that figure, I am happy to accept the recommendation made in the report. It is not the provision of 2,500 additional inpatient beds yesterday or tomorrow but between now and 2031, which works out at about 200 or 250 a year. We would like to front-load that number, but one cannot built hospital wings and new hospitals all that quickly. As I mentioned, we will have about 190 additional beds in hospitals this year and we are working to see how quickly we can front-load that number, if possible. It is being worked on as part of the capital plan.

Photo of Timmy DooleyTimmy Dooley (Clare, Fianna Fail)
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Spin.

Photo of Leo VaradkarLeo Varadkar (Taoiseach, Department of An Taoiseach; Dublin West, Fine Gael)
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When it comes to consultants, I think it was the Hanly report that recommended we needed about 4,000. As that is probably a little out of date at this stage, we will need to update it also. It takes a long time to train a consultant and having trained so long, a lot of them do not want to do certain jobs. We need to be realistic about how many we can recruit on an ongoing basis and advertise posts for which people will actually apply. Unfortunately, while there will be a lot of applicants for some posts in the big Dublin hospitals, there will not be for others. We need to be realistic about that, too. There are places where people want to work and places where they do not. That is just the reality.

There was one other part to the Deputy's question. I am sorry, but I have forgotten the next part.

Photo of Michael LowryMichael Lowry (Tipperary, Independent)
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In the 1970s a group of forward-thinking individuals set up a voluntary committee to meet the needs of children with special needs in south Tipperary who were at home and not receiving an education. The town of Cashel now boasts that it has the invaluable service provided by two special schools, Scoil Chormaic and Scoil Aonghusa.

Some 320 special needs pupils from all over County Tipperary and parts of the bordering counties of Waterford, Kilkenny, Cork, Limerick and Offaly attend both schools.

Scoil Aonghusa is experiencing a major crisis at present. A child attending the school will have little or no speech and may never acquire it. He or she will find it very difficult to learn new skills and will need support with daily activities such as mobility, toileting, eating, dressing, washing and keeping safe. The children have health problems including seizures and dietary and digestive issues. They have sensory issues such as visual impairment and-or hearing impairment. They have psychiatric conditions and difficulties with social skills. Without a doubt, these are some of the most vulnerable children in our society, yet there is shameful neglect and under resourcing of special schools.

Scoil Aonghusa has 97 students with intellectual, physical and huge complex needs in a building which is totally unfit and unsuitable. It was originally built in 1985. Some 80% of the students are non-verbal, 30% are physically disabled and 50% present with varying degrees of aggressive and destructive challenging behaviour, with the ability to cause injury to themselves and others. Due to overcrowding, four classrooms have been rented from an adjacent property. Some 19 junior ASD pupils have to be transported on a daily basis from the school to another rented building in the town, which is a mile away. Ten students, who have life-limiting conditions, are sharing a classroom which was built for six. There is no proper PE hall or assembly area. There is one changing facility in the school with a hoist for the needs of the children. There is no longer a dining room because it has been turned into a classroom. The children are eating in their classrooms.

Traffic congestion is a huge issue. The area is an accident waiting to happen. It is chaotic because 27 buses use the only entrance to the school building to enter and exit twice daily. Some 60 staff enter and exit through the same entrance. A boxroom is called a doctor's consultation area, but it is simply too small and unfit for purpose. The school is relying on the generosity of staff, parents and friends of the school to fundraise in order to meet the small shortfall from the Department. Parents have told us of their frustration, desperation and sense of isolation due to the fact that their special children cannot access adequate supports and services.

Children with special needs in our society do not have a voice. Scoil Aonghusa, on behalf of its pupils, is appealing to the Taoiseach to intervene and recognise the ongoing crisis it is living with on a daily basis. I ask the Taoiseach to ensure that we can expedite a new building and facilities on the Scoil Aonghusa site.

3:00 pm

Photo of Leo VaradkarLeo Varadkar (Taoiseach, Department of An Taoiseach; Dublin West, Fine Gael)
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The Government's aim is to ensure that every child, especially those with special educational needs, can fulfil his or her potential and avail of all of the educational opportunities available to him or her. During the worst years of the recession when public spending was cut across the board, it was one of the areas which was protected from spending reductions. In fact, resources grew throughout the recession and continue to do so.

The Department targets policies and supports for students with special educational needs to support their participation and progression across the continuum of education. For example, last year the Department of Education and Skills invested €1.78 billion in the special education budget, which is now almost a fifth of the entire education budget and is more than we invest in higher education. There has been a 44% increase since 2011, when the change of Government occurred.

The number of special needs assistants increased during the same period by 32%, from 10,575 to 13,990. As I said, we now have more special needs assistants in the country than we have gardaí or doctors. The number of special classes has also increased by 120%, with over 600 new special classes opened since 2011. We now have 1,100 special classes. The new model for allocating resource teachers to schools has been successfully introduced, with 900 additional teachers allocated from September last year to support the model and ensure that children with special needs can access the teaching supports they need.

That is a reflection of the enormous needs that exist in our community but also of the Government's very large and robust response.

I understand that Scoil Aonghusa has applied for major capital funding for the provision of 12 new classrooms, a general purpose hall and additional ASD facilities, together with improvements to mechanical and electrical services. The application is currently being considered by the Department of Education and Skills. Arrangements are being made by the Department to carry out a technical site visit in the near future in order to assess the existing accommodation and how best to provide the accommodation required to meet the long-term needs of this particular school. I will ask the Minister for Education and Skills, Deputy Bruton, to update Deputy Lowry once the site visit has taken place.

3:05 pm

Photo of Michael LowryMichael Lowry (Tipperary, Independent)
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It is important for the Minister for Education and Skills to understand that the school building committee has sourced and purchased land adjacent to the current site. The school committee has also privately funded the drawing up of plans which have been submitted to the Department. The principal of the school has clearly stated that the current situation cannot continue and that all possible adaptations of the existing building have already been exhausted. The critical state of the existing building means that staff are in constant and imminent danger. Already this year, three members of staff at the school are on injury leave. That cannot be allowed to continue. I ask that the Minister for Education and Skills address the chronic overcrowding and the unacceptable lack of facilities at Scoil Aonghusa. What we need is an urgent action plan to address and remedy what is an intolerable situation for management and staff at the school and the pupils who attend it.

Photo of Leo VaradkarLeo Varadkar (Taoiseach, Department of An Taoiseach; Dublin West, Fine Gael)
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I am informed that the enrolment of the school for 2017 and 2018 is 97 pupils. That represents a 28% increase over the past five years, so this is clearly an expanding school - with a growing number of pupils - that is responding to the needs that exist in the local community. In terms of the Department's capital budget, its first priority when it comes to school building is what it has to be, namely, building new schools in areas of increasing population. This is because we cannot have a situation whereby there are children looking into empty fields and not having schools to go to at all. A huge amount of the budget is now being taken up by building new schools, very often in rapidly expanding areas where there are new families and no schools at all. That has to be the priority. Obviously, once that is covered, we can then move on to improving, upgrading and extending older schools. As I said, what is intended now is that a site visit will take place. When that happens, the Minister for Education and Skills will update the Deputy on the progress being made.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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That concludes Leaders' Questions, which, again, have run significantly over time.