Tuesday, 5 February 2019
Ceisteanna ó Cheannairí - Leaders' Questions
The health service is still in crisis. The nurses' strike today is discommoding a far greater number of services than the last one. Some 50,000 patients have had their elective procedures cancelled. It is a cause for alarm that emergency departments will come and are coming under extreme pressure today. We know of the comments from the Irish Association for Emergency Medicine. The 50,000 patients, on top of those who were affected last week, amount to a lot of people across hospitals and community services across the country. Respite care and rehabilitation services will also be severely affected as a result of today's action. Disability services have also been brought within the scope of the strike. The Psychiatric Nurses Association, PNA, is escalating its overtime ban tomorrow and Thursday. The ban will now operate for 24 hours and thereby include overnight rosters. Therefore, mental health services will also be severely impacted on.
The Government has known about this for a long time, but there has been an absence of substantive and meaningful engagement on its Government. I put it to the Taoiseach that last night's initiative, the proposals that emanated from the Ministers, Deputies Donohoe and Harris, at the eleventh hour, has only served to compound the problem, make it worse and escalate it. The proposals concern staff shortages, undergraduate education, future nursing needs and so on, but they were sent via a press release without any engagement with the Irish Nurses and Midwives Organisation, INMO, or the PNA.
The INMO's general secretary, Phil Ní Sheaghdha, described it as "the most cynical move I have seen in a long time". The unions have rejected it as Government spin and said it was massively disrespectful to the nurses and to patients. The Taoiseach cannot solve industrial relations disputes with such cynical PR manoeuvres. The approach that holds optics to be more important than substance will not cut it when it comes to an industrial dispute of this gravity and scale. Meaningful steps are required to be taken. Substance must replace spin in the resolution of this dispute. Being seen to do something by rushing out a press release is not the approach. Why not engage in mediation to create a meaningful process to set in train a process that would come within the aegis of the industrial relations machinery? Why not deploy somebody of the calibre of Kieran Mulvey, for example, to engage with both sides to develop such a process that would bring the Government and the unions together under aegis of the industrial relations machinery to resolve this issue? The resolution of this dispute will require creative approaches and solutions. It has happened in the past in other similar disputes. The Taoiseach has to engage substantively with the issue. I ask him to take an initiative similar to that which I have just suggested.
On my own behalf and on behalf of the Government, we profoundly regret the disruption that has been caused to patients, users of our disability services and people with mental health problems who have been adversely affected by the strike action today and last week. We will do all that we can once this dispute is resolved to catch up on the lost work that was done, as we did last year when a number of days' work was lost as a consequence of the storms. I want to recognise that cover is still being provided in maternity hospitals, for palliative care, for most cancer care and in our emergency departments. There has been considerable engagement in efforts to resolve this dispute before now. For example, the whole issue of recruitment and retention was examined by an independent body, the Public Sector Pay Commission, which made recommendations for a €20 million package of allowances and additional increments and career progression for nurses, at a cost of €20 million a year. That was rejected by the nursing unions, or at least by two of the three nursing unions. There was an engagement at the Workplace Relations Commission, WRC. There was also an engagement at the Labour Court. We are open to further engagement and will be happy to have it, either at the WRC or the Labour Court, should it decide to intervene.
I appreciate that the nurses' unions felt that the offer to engage in further talks at the WRC was discourteous as they heard it through a press release rather than through a letter or direct contact. We will make sure that does not recur. At the same time, though, we should not forget that tens of thousands of people found out through the media that their respite care was being cancelled this week and that their day care was being cancelled, too.
In terms of the resolution of this dispute, I believe it can be resolved. I spent a little bit of time reading about the last major nurses' dispute which happened in 1999. Deputy Micheál Martin was in government himself at the time and he may remember better than I can.
It went on for nine days and was ultimately resolved in the Labour Court at huge inconvenience to patients. I do not want that to happen again. I certainly would not like to see a repeat of 1999 when a strike went on for nine days. I believe it can be resolved. That requires engagement and the Government is open for engagement through the WRC. However, it can only be resolved in a way that is affordable for taxpayers and fair to all public servants with whom we have a pay deal already. We have to honour that deal. We are not in a position to break it by doing a special deal with one group of staff and saying to the others that there is nothing for them. That would not be right. They are the parameters under which this can be resolved and I am sure that if all sides accept those parameters, we can resolve this dispute swiftly.
It is the same script but a different day. The Taoiseach mentioned that the Government will help patients catch up. The only catching up that will be done will be done by nurses and doctors when this strike is over. The Taoiseach and his colleagues will not have to play catch-up. Did I hear the Taoiseach correctly when he said that he did not send any direct letter to the nursing unions in terms of last night's offer and that no direct contact was made? The Taoiseach said he will make sure it will not happen again. Is the Taoiseach serious? This is a very grave dispute, and that is a pathetic response. Has the Taoiseach reprimanded his Ministers? What were they doing last night? Was it just a cynical PR exercise? It is not good enough to say that unions did not engage. The unions have been engaged with the HSE about strike action for a long time. It is appalling that the Taoiseach should come here today and effectively say that the Government engaged in optics over this issue last night and that it did not make any direct contact with the unions over the offer that was announced last night. He clearly just wanted to be seen to be doing something. It was all done for the optics. That is appalling and a pathetic way to approach such a grave dispute. The Taoiseach should read up on the issues and not remain in denial about the recruitment and retention crisis. It is very real. We are haemorrhaging so many graduates from our colleges to the UK and other countries. I suggest that the Taoiseach should appoint someone of the calibre of Mr. Kieran Mulvey to engage in mediation and to create an environment in which both sides can get together.
-----to do that, with the HSE and others. The Government is also open to the possibility of a Labour Court intervention. Of course we have had consultations with the Irish Congress of Trade Unions, ICTU, and others about the possibility of an intervention. However, everyone feels that an intervention can only happen at the right time, when there is adequate space and adequate agreement so that we can proceed into a process. As I have said before, the parameters that have to be agreed are twofold. First, any agreement we reach has to be affordable for the taxpayer. We are not in a position to engage in borrowing to fund pay increases, and it would not be responsible to do so, particularly at this time. Second, any agreement we make, especially anything concerning pay, must be done under the existing Public Service Stability Agreement, with the involvement of ICTU. It would not be fair to 300,000 other public servants, with whom we have a pay deal and who are not on strike, if we gave a special deal to one group and then say to others that we cannot do the same for them. That would not be fair.
The very fact that nurses and midwives are engaged again today in industrial action is a reflection of the Taoiseach's incompetence. The failure of his Government to address the recruitment and retention crisis now gripping the health service and his inability to grasp this issue has led to a national crisis. It is not good for taxpayers that nurses and midwives are on picket lines. Has that occurred to the Taoiseach? It is not good for citizens or anyone who relies on the services of the HSE, and it is certainly not good for the nurses and midwives themselves. I spoke to many of them this morning at Holles Street and St. James's Hospital. I was there to demonstrate solidarity, but more importantly to listen to what they have to say. None of them wanted to be on the picket line. They are very angry and upset, but they are very determined. They want to be back at work and doing what they do best, which is caring for their patients. We all agree that they are, after all, the backbone of the health service. They work in very difficult and stressful circumstances and conditions. The reality, no matter how the Taoiseach tries to spin it, is that their pay and working conditions have given rise to a recruitment and retention crisis within the system.
I spoke to one midwife this morning who gave an example of just how broken the system is. She works in Holles Street. On one particular day she was the only midwife on a ward of 12 women. There was a woman there who had just had a C-section who needed help.
The woman was in discomfort. The midwife told the story that the woman would not press the bell or look for the midwife's attention because she could see just how stressed the midwife was and just how chaotic the scene was. What kind of service is it when someone in need of assistance feels moved not to ask for help when lying in a hospital ward? It is unacceptable.
The Government's so-called approach to the unions was not only discourteous; it was also disrespectful, utterly inept and had all of the hallmarks of its mishandling of this scenario to date. The Taoiseach has now conceded on the need for engagement and that is a start. What he now needs to understand are the parameters of that engagement. They must include no preconditions, direct engagement by the Taoiseach as Head of Government and direct engagement with the nurses, midwives and their unions. Nothing short of this is going to work. If the Taoiseach is interested in resolving this dispute in the public interest, he will engage directly and with no preconditions; he will step into the breach as Head of Government and respectfully listen to the proposals coming from the nurses and their representatives and weigh them up. Then, if he is wise, he will act on them.
We have had a system for resolving industrial relations disputes for 20 or 30 years now, including the time of the last nursing strike that went on for nine days in 1999. That is something I do not want to see repeated. Under that system, we deal with these disputes through the Workplace Relations Commission and the Labour Court as the final arbiter in such disputes. That is the best way to manage industrial relations disputes. It has worked for 20 or 30 years and I have no doubt that it will resolve this dispute also. The Government and the various agencies of government are willing to engage through the WRC, as was offered yesterday, or the Labour Court, should it determine that an intervention is appropriate.
Reference was made to recruitment and retention. As I have said before, I acknowledge that this is a real issue. It is a real issue in large parts of the public sector and the private sector as we approach full employment. As the nursing unions have stated, when it comes to healthcare, we live in a very competitive environment where people with healthcare degrees can work in almost any part of the world. Notwithstanding this, since we lifted the recruitment embargo four or five years ago, there are some 3,500 more nurses working in the health service. That is a significant increase. In the past year alone, excluding students, approximately 800 more nurses and midwives are working in the public service. While there are plenty of people leaving, more are coming home or from other countries. While there are plenty of people leaving the profession, there are more coming into it. Our turnover rate of 5% is approximately one third of that in Australia, yet it is a struggle to recruit and retain. Deputies will know that we pay more than Northern Ireland, Scotland, Wales and most of the United Kingdom, with the exception of London. We pay more than most of Europe. All of those places have recruitment and retention challenges. Other places pay more. Australia pays more, as does the United Arab Emirates. Those areas and countries also struggle to recruit and need to recruit from all over the world. Unfortunately, there is no guarantee that an 8%, 9%, 10% or 12% pay rise will actually solve the recruitment and retention problem. It has not solved the problem for Australia or the Middle East.
We are two days in and there are seven days to go, but all the Taoiseach has to offer is robotic monologues. Nothing he has said has within it the seeds of resolving the dispute. What can resolve it, as we have said to the Taoiseach consistently, is positive respectful direct engagement. That means engagement with no threats or sabre rattling on pensions or pay, engagement with no preconditions, engagement not to carve up a special deal but such that nurses and their representative bodies will believe the dispute can be resolved within the strictures of the current public pay agreement.
I have said this to the Taoiseach several times in the Dáil. The nursing unions have said this to him publicly. I have no doubt that anyone with an ounce of wit would give the Taoiseach the same advice privately, yet he was unwilling, as Head of Government, to make the very necessary move. We are two days down and seven days of further action are planned. If this strike continues, the fault lies with the Taoiseach. The blame lies with his spectacular inertia and refusal to act.
Listening to the Deputy's contributions in this Chamber and her advice on making agreements or managing industrial relations, one would be mistaken for thinking that somehow she was successful in this area. She and her party hold the world record for failing to come to an agreement and form a coalition in Northern Ireland. There is no advice that she can give us on negotiations, conciliation or reconciliation-----
-----and she has no credibility given her own record of being a commentator and a bystander in Northern Ireland when she should be involved in forming a coalition government there.
To repeat what I said earlier, and I mean it sincerely, this dispute can be resolved. The Government wants it to be resolved. We understand the grievances that nurses and midwives feel about their pay and terms and conditions. We understand the enormous public support they have and will continue to have. The Government wants to resolve this dispute. We are willing to engage in talks in the Workplace Relations Commission. We are willing to accept an intervention by the Labour Court if it determines that is advisable. It can be resolved but it must be resolved within certain parameters which all sides should be able to accept. First, it has to be affordable for the Exchequer. We cannot fund pay increases with borrowed money, particularly given the uncertainty ahead. Second, it must be fair to all other public servants, the 300,000 public servants who work very hard, with whom we have a deal and who are not on strike. Any pay issues must be paid under the umbrella of the Irish Congress of Trade Unions and the Public Service Stability Agreement.
Between 2011 and 2015, we were fighting for our survival as a country. Every major project was checked and scrutinised to control costs and deliver value for the people's money. This Fine Gael Government seems to have adopted a Celtic Tiger attitude towards overspending. Just ten months after telling us that the cost of the national children's hospital on the St. James's site was to be €938 million, Fine Gael is now telling us that the final cost could be €1.73 billion or more, nearly double the previous cost. As the Minister for Health, Deputy Harris, has said, we are at the point of no return. There is a vast crater in St. James's, and having dug themselves into this hole, the Government seems to have no choice but to keep digging to try to find a way out.
However, the Government's story does not stand up. We have been told that the civil servant appointed to the National Paediatric Hospital Development Board was there in a personal capacity. That is not true. The Department of Finance Circular 12/2010 sets out in detail that civil servants appointed to non-commercial boards must inform if a matter of serious concern arises. It is a requirement for civil servants on boards to ensure that their concerns are first raised at the board, noted in the minutes and actions agreed. The circular is crystal clear:
The Minister must be notified without delay where: (i) There are serious weakness in controls that have not been addressed despite being drawn to the attention of the board or the Chairman;
(ii) There is a significant strategic or reputational risk to the body that is not being addressed.
A Government circular overrides any confidentiality imposed by a board itself. How is it possible that this did not occur in one of the State's largest developments?How is it plausible that the Minister for Public Expenditure and Reform was unaware of cost overruns until November last, as he has asserted? The Minister for Health, Deputy Harris, has said that he was aware of some of the costs as early as last August. Did it really take another three months for the Minister, Deputy Donohoe, to be informed? Either he did not know what was going on and did nothing or else he did not know what was going on until November. It is unimaginable that the Minister for Public Expenditure and Reform was kept in complete ignorance of public expenditure.
Surely as the Minister overseeing public spending, he would have received monthly, if not weekly, updates on the progress of a project of this scale and significance. Why apparently did it take three months for the Minister for Health to inform the Minister for Public Expenditure and Reform about major cost overruns in the flagship programme of the Department of Health? How did the Government present a budget to this House at the end of last year that is already €100 million short in its capital programme?
Thanks very much for the question on the important issue of the children's hospital. It is a project about which people have been talking since the 1960s. If one goes back in the Dáil record-----
The satellite centre in Blanchardstown is built and will open to patients this year, followed by the centre in Tallaght next year and the main hospital in 2023. Decades of promises will actually be delivered on by the Government, something that the children of Ireland need and deserve. I appreciate that it is right and appropriate to talk about the cost and the cost overruns, but we should never forget the value of the project.
To answer the Deputy's questions, the Minister for Health was first made aware of an issue surrounding rising costs at the national children's hospital in August. He did the right and appropriate thing.
When I found out about it in November, around the same time as the Minister for Public Expenditure and Reform, I responded in the same way as others in this House, first, with disbelief in struggling to believe how the price had gone up again.
-----and to say, "Go back, negotiate with the companies, get the figure down, find out if we can reduce some of the specifications in the hospital to reduce the cost and find out if retendering was an option."
Once upon a time Fine Gael was concerned about fiscal prudence and proper public financial management, but, clearly, no more. We all know the history and value of the project. We do not need to be lectured on it. The Taoiseach needs to address the questions put to him. He is not talking to someone who does not understand budgets. The notion that the Minister for Health was aware of a significant overrun from August and did not tell the Minister for Public Expenditure and Reform for three months-----
Meanwhile, there was a "battle" going on in the national media about current expenditure overruns. An overrun of €600 million on the current side was a matter of "battles", but no one mentioned that, by the way, there was a €400 million or €500 million overrun on the capital side also. That no one even looked at this for months is not credible. The net point is that the Minister for Public Expenditure and Reform had his own man on the board with a responsibility, according to the Government's own circular, to report to him.
Did this happen, and if not, why?
-----and the same scrutiny was then applied.
In terms of corporate governance, corporate governance has changed quite a lot since 2010. Corporate governance and corporate rules do not override Government circulars. If somebody is on a board, his or her fiduciary and legal responsibilities are to that board and the correct line of accountability is-----
The Ceann Comhairle said the response of the Opposition was intolerable. As somebody who sat on the Committee of Public Accounts Thursday last and listened to a complete litany of failure of governance, I find the Taoiseach's response intolerable but it is no doubt something we will return to later.
We should not need the nurses to take to the streets on strike, for only the second time in 100 years, to tell us that the health system is not safe. Prior to this strike action, which is being taken as a last resort, the nurses have repeatedly informed this Government and successive Governments, and the Minister for Health and his predecessors, including the Taoiseach, how precarious the situation was and remains given the absence of front-line staff. In August last, for example, the INMO figures showed that that month was the worst on record for overcrowding in hospitals across the country. Of course, we know the detrimental effects of this overcrowding. Dr. Fergal Hickey repeatedly tells us that, in any given year, 300 to 350 premature deaths are directly related to the time spent on a trolley. In response to these figures, the nurses took what action they could, stopping short of strike action at that point. They went out and protested. They were forced into this strike action. I give that background. Tomorrow, the GPs are going out on strike, telling us that their system is not working either.
My question is in the context of that background in Galway city where, in 2017, two theatres closed in Merlin Park. There was a high-level meeting in October following which we were told that serious action would be taken and modular theatres would be put in place. It is interesting that the two theatres were put out of action by rain. All the while, the Government is putting money into a rainy day fund, not for the health system, not for education or housing, but to bail out a financial crisis in the future.
Two theatres closed because of rain. I have a list here that I have not the time to go into. This is where trust and confidence comes into the system, as is the case with the children's hospital. Throughout 2018, other Deputies and I have repeatedly highlighted this. I was told in responses to questions that tender documents had gone out. I was told that contracts were to be signed. Here we are, in 2019, and the two theatres are still closed. The latest chapter in this saga is that a consultant has written to all Deputies in Galway in an unprecedented move on behalf of all his colleagues to tell us that the situation is exactly the same as it was in 2017. What has happened? When will the theatres be opened?
Almost one year ago the Taoiseach told me that he could not take a hands-on approach and that the people in charge were the Minister for Health and hospital management. One year later, there has been no progress whatsoever. It goes to the heart of the difficulty the Opposition has with the Taoiseach and his Government. There has been absolute spin and lack of trust in the answers. I want a clear answer today. What inquiries have been made by the Taoiseach or the Minister regarding the two theatres and when will they open?
The first issue the Deputy raised was the children's hospital. The terms of reference for the review by PricewaterhouseCoopers, PwC, into the escalation in costs are currently being revised.
The review will deal with the accountability of relevant key parties, functions and roles and the prohibition on making any findings against individuals will be removed. It will establish the sequence of events in the cost increases experienced by the project, establish what was known, when and by whom, and cover the bodies, including the National Paediatric Hospital Development Board, NPHDB, its committees, the HSE and the Department of Health. The review will also be asked to identify any areas where potential cost savings or reductions, which are consistent with the applicable contractual undertakings, may be found.
Merlin Park University Hospital, MPUH, provides elective medical and surgical services, renal services and a haemodialysis unit, and two designated rehabilitation units, along with a number of number of specialist outpatient clinics. In September 2017, leaks developed in the roof of the building in the hospital that houses the two orthopaedic theatres. Managers temporarily suspended operations for one week to facilitate repairs. Following the deferral of elective orthopaedic procedures in 2017, the hospital facilitated the transfer of elective sessions to University Hospital Galway on a limited basis with the support of Merlin Park staff and eight orthopaedic elective beds. In addition, some minor procedures were undertaken in hospital one in Merlin Park and-----
This is the question and the answer. In March 2018, remedial work facilitated the opening of one theatre in MPUH, which advised that it is working towards restoring the full elective orthopaedic service as quickly as possible. A tender process was recently undertaken regarding the provision of two modular theatres for orthopaedics on the MPUH site. A successful vendor was selected for the project and an enabling contract has been signed between the HSE and the modular provider. Contracts have been exchanged between both parties and are currently with the HSE national estates division. A planning application was submitted on 20 December 2018, and subject to a successful determination of that planning application, which I understand is outstanding, it is intended that the work will proceed as planned.
I wish the Taoiseach had addressed my question quicker and not given me a history lesson. I have all of the documentation here. I have raised this issue repeatedly. The Taoiseach is telling me that contracted documents have been exchanged. During last year, I was told twice that they had been exchanged. We are now in receipt of a letter from the consultant orthopaedic surgeon telling us that 1,500 patients are waiting for complex joint replacements, spinal surgery, and foot, ankle and shoulder surgery, while the waiting list continues to expand exponentially. That is the situation; chronic and acute pain is being suffered by these patients, yet the Taoiseach stands there telling me that contract documents are going to be exchanged. At the very least I would have expected him to tell me what happened that they were not exchanged last February, which is when we were told they were being exchanged, and at the very least to learn from the children's hospital project and to give us the information having made the inquiries. Last year, the Taoiseach told me that he was not aware of the question and that I had not notified him. I notified him of today's question so that he would not come to the Chamber unprepared and he would have checked the situation. This is unacceptable in a city where the main hospital is creaking at the seams on a congested site, but with a 150-acre site available in Merlin Park. We are going piecemeal and piecemeal, and we cannot even provide modular theatres, which are not the answer. The answer is a new hospital. In the meantime, we would like a little bit of honesty about modular theatres.
There are a number of things to mention. An awful lot of people are waiting a very long time for orthopaedic operations and procedures, and, often, to see a specialist in the first place. It is important to acknowledge that the number of people waiting more than 12 weeks for operations and procedures, which is the Sláintecare target, is now at a four or five-year low. This includes hips and knees and other orthopaedic operations, so we are making a lot of progress in that area-----
-----but there is a long way to go yet in that regard.
On the MPUH issue, the Deputy will be aware that, very sadly and unfortunately, the Galway hospice planning application for Merlin Park was refused.
As such, Merlin Park as a solution for new hospital developments must be considered in the light of planning problems at the site where planning permission for the hospice has just been refused. To answer the Deputy's specific question, a vendor has been selected for the project and contracts have been exchanged between the parties.
It is with the HSE's national estates division in respect of legals. A planning application was submitted on 20 December 2018. Subject to it being successful, work will proceed as planned.