Pearse Doherty (Donegal, Sinn Fein)
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Let us call a spade a spade because doctors and nurses know what the Taoiseach was at. They know he was attacking them. They know he was trying to shift the blame for the lack of capacity and the lack of recruitment and retention policies the Tánaiste's Government has failed to deal with onto the front-line workers. It has not been lost on those nurses and doctors that when the Taoiseach was Minister for Health during the Christmas period of 2014 and the new year of 2015, he was holidaying in Miami at a time when the trolley crisis in this State peaked to record levels. He has some cheek. He should listen to doctors and nurses, and the media reports on "Morning Ireland" this morning. There will be more consultants in the hospital in Cork in January than there will be at any other time during the year because of leave. This is about a blatant deflection of the failure of Government to deal with this issue. The Tánaiste talks about prioritising capacity issues. I am sick to the teeth telling him that there is a 20-bed ward in the hospital in Letterkenny that the management want opened. They made an application a year and a half ago. The HSE wants it open. The Department will not open it. This is no longer a winter problem; it is an all-year-round problem. There were 700 patients on trolleys in March, 600 this month and 525 today. This is an all-year-round crisis. The Government needs to get to grips with it. The Tánaiste should do the decent thing and apologise to those nurses and doctors for the insulting and hurtful comments the Taoiseach and the Minister for Health made and on which he is doubling down here today.

Simon Coveney (Cork South Central, Fine Gael)
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People in our health service work extraordinarily hard, in many cases under very difficult circumstances. We know that in government. The Taoiseach is a doctor, and he has a very clear understanding of the way hospitals work. What we are at here is about short-term planning for what we know will be a very pressurised winter period, and addressing all issues to do with that, from capacity, to try to de-escalate challenges in advance of the Christmas period within hospitals, to increasing investment with regard to social care to get people out of hospital care, where possible, and ensure they are looked after properly in different settings, to create space within hospitals. We are also trying to have an honest conversation about rostering to make sure that the clinical leadership and health team leadership is in place over the most pressurised time of year. Nobody is arguing that it is not a year-round challenge to address capacity issues. That is the reason we saw massive increases in the budget for the health budget.

Much of it goes into increasing capacity, including staffing and capital investment. However, there is a short-term challenge for which we need to plan. To answer the Deputy's question, the winter plan will be finalised shortly and available for people to see.

Pearse Doherty (Donegal, Sinn Fein)
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Before the winter.

Simon Coveney (Cork South Central, Fine Gael)
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The issues we need to address require an honest and practical conversation. That is what the Taoiseach has contributed.

Brendan Howlin (Wexford, Labour)
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Many of us across the House, rightly, were up in arms about the crass remarks made about Travellers by one of the recent candidates in the presidential election, but it is not enough for us to decry negative stereotyping and hate speech. We have to take seriously the issue of Traveller margninalisation. The national Traveller and Roma inclusion strategy report states the rate of unemployment among Travellers is 80%, which affects a staggering four out of five. Only one in eight Travellers, or just 12%, completes secondary education. By any yardstick, they are shocking statistics. If they described a minority group in another jurisdiction, we would, rightly, be concerned and voice our views about it, but we continue to allow that situation to prevail. I am not persuaded by any argument to the effect that more is paid in social welfare to Travellers than to others or that because they have large families, there is a disincentive to work. Other large families enter paid employment and welfare payments are designed to support families in work.

There are other issues behind the statistics, including discrimination. Perhaps there is also the lack of a clear vision for the role of Travellers in the economy and society. Across the board, not just for Travellers, there is a decline in work opportunities for people without formal qualifications or skills, yet formal education does not work for everybody. We need robust alternatives such as apprenticeships for those who drop out of school at second level. Secondary school education is mandatory up to the age of 16 years or at least until one attempt is made to sit the junior certificate examinations. Should that opt-out be removed and an age limit applied in order that everybody would be required to stay in education until he or she is 16 years old? Will the Government consider whether specific apprenticeship schemes for young Travellers should be instituted, resourced and put in place across the country? Will it consider other forms of training and skill development for Travellers and impose the same mandatory attendance requirement based on age as that applied at second level? However, all of the training in the world will not make a difference if there are no jobs and businesses open, available and willing to employ Travellers. Will the Tánaiste outline the Government's vision for the role of Travellers in our society? There has been much hoopla about ethnicity in the past year. It is a very important milestone, but it has to have real meaning. What specific robust measures will be taken to change the disastrous and unacceptable statistics for employment and education among Travellers?

Simon Coveney (Cork South Central, Fine Gael)
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I thank the Deputy for asking this question. It is a sensitive but very important issue on which the House needs to continue to provide leadership. People will remember the former Taoiseach, Deputy Enda Kenny, making a statement in March 2017 in announcing the recognition of Travellers as an ethnic group in Ireland. Since that statement, the Government has published the national Traveller and Roma inclusion strategy 2017 to 2021. The strategy contains 149 actions grouped under ten themes, including cultural identity, education, health, anti-discrimination and equality. A celebration event to mark the first anniversary of the formal recognition of Traveller ethnicity by the Taoiseach in Dáil Éireann took place in the Royal Hospital, Kilmainham in March this year. The event was targeted primarily at members of the Traveller community and the relevant NGOs, State agencies and Departments that work on Traveller issues. However, it was fully inclusive and open to any member of the public who wished to attend.

We are looking to build on our achievements in changing the conversation between the Traveller community and the settled community, one that did not have enough trust and, in some cases, still does not. If we are honest, there is an underlying prejudice, driven by fear, among many in the settled community. The only way we can address it over time is through responsible politics that recognises that, as a minority ethnic group in Ireland, Travellers have been marginalised for many years. As a result, their educational, housing and healthcare needs have not been met, resulting in a build-up of mistrust and tension between the two communities. There are lots of anecdotal examples. Settled communities are fearful of integration and facilitating housing solutions. As a result, local authorities have been unable to deliver the supports needed. However, we cannot allow that fear and prejudice to dominate how the issue is dealt through policy development and investment - quite the opposite, in fact. This Government wants to be more generous, reach out more comprehensively, invest more and insist at both national and local level on the resources made available actually being spent in ways that will achieve real outcomes. We are more than open to considering new suggestions, including apprenticeships and getting a buy-in among employers or other elements of society that could prove helpful in what must be a transition over time. We must change the narrative and relationship between Travellers and communities that have hang-ups and fears about them.

I pay tribute to the Minister of State, Deputy Stanton, in dealing with this issue. He has shown remarkable leadership and put a huge amount of time into dealing with a hugely important issue that is challenging from a policy perspective. I know that he will continue to give leadership in that regard.

Brendan Howlin (Wexford, Labour)
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The Ceann Comhairle might forgive me for thanking him for inviting Travellers and representative groups to the Oireachtas last night. It was a very worthwhile initiative that should be mentioned.

I agree with the Tánaiste. We need to have an open conversation, not on the margins but in the centre. The statistics are truly shocking. They are not just statistics, they reflect the reality for people. The way to change them is through education, training and, ultimately, employment. As a community and society, we have failed to do this. Let us not simply voice our horror at some of the comments made about people on the margins. Let us actually find a solution to ensure the concept of true citizenship for all citizens can be vindicated in this republic. That would be a vindication of all the rhetoric about appreciating ethnicity and so on. If we believe what we are saying, let us take real initiatives in that regard.

Simon Coveney (Cork South Central, Fine Gael)
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To make the Deputy's point, on which I agree with him, there is no lack of effort on the Government's part, but the outcomes are not changing. For example, in the latest budget we allocated €15 million for Traveller-specific accommodation, a 25% increase on the figure for last year. Looking at the recent history of this issue, it is no secret that the delivery of Traveller accommodation has been challenging, to put it mildly. Budget allocations have simply not been spent. In the ten years between 2008 and 2017 the Department of Housing, Planning and Local Government recouped in excess of €105 million to local authorities from a capital budget of €156 million. That represents a collective drawdown of 67% of capital funding by local authorities. In other words, money that has been made available cannot be spent because of the politics and social challenges surrounding the issue. We need to work with Traveller representative bodies and the Traveller community to provide reassurance.

We also need to ensure there is leadership at local government level, as well as in national policy, to be able to change the narrative that, unfortunately, has resulted in so many in the travelling community being desperately disadvantaged through the non-delivery of many of the essential services to which they should be entitled.

Joan Collins (Dublin South Central, Independent)
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I raise with the Tánaiste two issues regarding the health service, namely, the ongoing and now permanent crisis in the service and the implementation of the all-party Oireachtas report, Sláintecare. As we enter another winter period, the flaws in the public health services are being cruelly exposed. If there is a flu epidemic, the situation will be catastrophic. The Tánaiste will quote figures on extra funding, in particular, €2.9 billion for capital investment on infrastructure, additional beds, equipment and mental health over a ten-year period. I put it to him that this is not a solution but a sticking plaster which, given demographic factors, will barely maintain existing levels of care. This level of investment was called for in the Oireachtas report but was crucially linked to a €3 billion special fund to deliver Sláintecare over a six-year period. There was no mention of this special implementation fund in the health budgets of 2018 or 2019. A mere €20 million has been allocated for 2019 to be ring-fenced for the Sláintecare implementation programme. I put it to the Tánaiste that despite statements to the contrary and notwithstanding the appointment of Ms Laura Magahy, a capable health professional, to oversee the implementation programme, officials at a high level in the Department of Health are in charge of the process and will ensure that Sláintecare, if not quietly parked, will never be implemented as envisioned in the all-party report.

Actions speak louder than words. The Government's Sláintecare implementation strategy outlined earlier this year, while making all the right noises, is a step back from the Oireachtas report in terms of timelines and funding. There is no commitment to universal access. Expanding eligibility still involves means-testing, which is the opposite of universal access. The Government either does not understand what universalism is or does not want to understand it.

Does the Tánaiste agree that there is simply no political commitment or funding for Sláintecare, which will mean the continuation of a broken system that is not fit for purpose and fails to deliver the service the people deserve? It will also mean the continuation of the enormously stressful and poor working conditions experienced by those who work in the health service, particularly the front-line staff who were referred to earlier.

Simon Coveney (Cork South Central, Fine Gael)
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The Government is absolutely committed to the Sláintecare approach to reforming and changing for the better the healthcare system. The point of trying to get all-party agreement on the way forward was that this will take time and will involve a number of different Governments in its delivery. Whoever makes up those Governments, the fact that we now have all-party agreement on the way forward for health reform means, hopefully, that there will be consistency from Government to Government over a period of time. One of the big challenges in health reform has been that different Governments, on coming into office, have changed the policy approach to healthcare, which cannot be reformed in one election cycle. What we have now is an agreed approach to move towards universal health support and provision through Sláintecare and a series of other changes. Some changes will take time, while others can happen quickly.

In terms of the budgeting of healthcare, we have seen a significant increase in the availability of resources from this year to next year and in terms of expenditure since last year. Approximately €1.2 billion in extra funding will be provided next year. Nobody can question the Government commitment to funding a better health service. Nor should anyone question the Government's commitment to adhering to the Sláintecare model. That is the model we will follow. However, we cannot go from A to Z in one year or one budget cycle. This will take incremental change across multiple areas and the maintenance of a reasonable and decent health service through the transition period, which will be extremely challenging. It will deal with everything from increased skills and bed capacity to an increased emphasis on primary care to keep people out of hospital, increased home care and many other areas. We need to ensure the Sláintecare model of universal support ensures that people do not get health provision on the basis of their income levels but as a right or service that the Government wants to deliver through a new model of healthcare. This takes time but all of the trends and policy direction the Government is committing to at present are consistent with the Sláintecare approach.

Joan Collins (Dublin South Central, Independent)
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The funding committed was already part of the Oireachtas Sláintecare report. What we were looking for was the extra front-loaded funding to implement Sláintecare over a period. It is all very well outlining various commitments but I would like the Tánaiste to respond on a number of key issues. The proposal in the Sláintecare report was that the implementation office would be completely independent of the Department of Health. The opposite has happened, which is a serious concern. The report called for the establishment of a national fund. That has not happened and there are no proposals for it happen. I ask the Tánaiste to respond.

The commitment to universal access will only become a real commitment with legislation which requires the Minister for Health to provide universal access to the public healthcare system at all levels. When will the Government introduce such legislation?

Simon Coveney (Cork South Central, Fine Gael)
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On the Deputy's final question, legislating for services and access to services for people is one thing but we must have the capacity to deliver them.

Joan Collins (Dublin South Central, Independent)
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That is what the extra funding was for.

Simon Coveney (Cork South Central, Fine Gael)
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If the Deputy is suggesting that we should have found another €600 million or another €200 million or €300 million for healthcare, that would have had to come from somewhere else in the budget.

Paul Murphy (Dublin South West, Solidarity)
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Take it from Apple.

Simon Coveney (Cork South Central, Fine Gael)
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This is a zero-sum game. Healthcare rightly continues to take a large portion of the overall budget. It has also rightly taken the lions share of the increased capacity for expenditure because that is where investment is needed. The priority in expenditure should be health and housing but there are limits to what we can spend, even in an economy that is growing at the pace we are currently enjoying. This is a necessary step-by-step incremental improvement consistent with the Sláintecare model that we all have signed up to and that I hope will be continued by future Governments, regardless of whether they involve my party. That is the way we need to see the implementation of the Sláintecare model delivered. Asks need to be realistic, year on year, in terms of the amount of funding available. A significant amount of extra funding will be spent next year compared with this year and I also expect major increases in funding the following year. As we can afford to introduce incremental changes and improvements to healthcare, the Deputy will see them happen consistent with Sláintecare.