Tuesday, 12 November 2019
Ceisteanna - Questions
Cabinet Committee Meetings
I propose to take Questions Nos. 1 to 5, inclusive, together.
The Cabinet Committee on Social Policy and Public Services last met on 21 October and is scheduled to meet again before the year end.
The committee covers issues relating to health and Sláintecare, education, children, equality, social inclusion; immigration; Irish language, arts and culture; and continued improvements and reform of public services. While the committee covers a broad range of areas and topics, its overarching aim is to introduce or reform public policies and services which help create an inclusive and fair society. The Cabinet committee considered a range of social policy issues over the recent period, including childcare; child protection and welfare issues; social enterprise; immigration and direct provision; gender equality issues; Sláintecare and health reforms. In addition to the meetings of the full Cabinet and of Cabinet committees, I often meet Ministers on an individual basis to focus on particular issues, including issues relating to social policy and public services.
There are some 2,000 or 3,000 undocumented children in Ireland born to workers who came here probably at the height of the previous boom. Approximately two thirds of these children were born in Ireland and one third outside Ireland. Every year since taking office the Taoiseach has gone to the United States and argued in favour of a pathway to citizenship for the undocumented Irish in America. I would like to think that we could agree as a House that we would offer a pathway to citizenship to these children, who have been left in limbo. Some of these children are now adults, others are in school and their rights to almost any kind of services in Ireland depend on the goodwill of the State. They do not have passports or status. It is a significant restriction, as it is for the undocumented Irish in America, on their freedom to pursue their education, social and work opportunities as best they can. I would like the Taoiseach to consider giving these children legal rights to become Irish citizens, a pathway similar to our proposals to America, and to let them and their families get on with their lives.
This Cabinet committee is tasked with considering health policy, including the Sláintecare report. The joint committee that launched this report aims to reorientate the health service to a universal single tier system. However, the Government's implementation strategy, as we always feared, is not moving the health service to universality. The barriers to care remain sky high. Charges for urgent scheduled care are still in place and the primary and social care ambitions set out by Sláintecare are a pipe dream.
In the first six days of this month, 319 patients were left waiting for a bed at the Cork University Hospital, CUH, 103 at the Mercy Hospital and 29 at Bantry General Hospital. I was in the Mercy Hospital yesterday week with my son and, despite a high standard of care, we could see that the system was under savage pressure. There were many elderly and very ill people on trolleys. Unfortunately, there is a lack of dignity for them. It is a disgraceful situation. There are 36 people waiting on trolleys there today. That is the second highest number in the State. Conor Deasy, of the emergency department in CUH, said that his colleagues had been placed in an impossible situation and that they "abhor the inhumanity, indignity and patient safety risk associated with treating patients, who require an inpatient hospital bed, on the corridor of the emergency department."
The Government has committed to delivering a universal health service over ten years. What focus has the committee given to the roadmap for universal access in its work this year and to the outcomes of the under-resourcing of patient care in all care settings?
In spite of the quite aggressive attempt to revise homelessness statistics downwards, the most recent figures continue to show the highest ever levels of adult and child homelessness. From the many statistics available to the Taoiseach, can he tell us when exactly he predicts that these numbers will start to decline? There is conflicting evidence regarding housing construction figures. Planning permissions are no guide to the building of houses. We know that from the strategic development zone, SDZ, figures, that the majority have not commenced, one year after receiving planning permission. Given all the spin deployed on the housing issue, many people are genuinely confused, or have been deliberately confused, about the true picture. It is clear that the core targets of Rebuilding Ireland, the Government's policy, have been missed. In the best possible scenario, the plan's targets have been missed every single year. Can the Taoiseach explain why Rebuilding Ireland's targets for new homes continue to be missed?
Earlier in answering Leaders' questions, he exuded a certain degree of complacency - everything is all right and it is moving in the right direction. Homelessness is not moving in the right direction. The attitude in Fine Gael seems to be that it is all rental, rental, rental, co-living and build to rent. I saw Senator Noone's statement about 88 units in Coolock, which used the phrase "100% social housing", as if that was terrible and should not happen. We need more social housing. The councils need to build more houses and the scale of housebuilding by the State should be far more dramatic than it is. It should intervene in respect of affordable and social housing.
On the broader issue of social policy, the Minister for Employment Affairs and Social Protection, Deputy Regina Doherty, was interviewed yesterday about the fact that her press adviser is paid €20,000 more than the average paid to those working for other Ministers. She did in fairness say on LMFM that not only does she sometimes put her foot in her own mouth but two feet when she opens her mouth so she went looking for the best. Does the Taoiseach think that is an acceptable justification for that particular allocation?
I welcome the news that the Minister for Health is set to report to Cabinet this week that eliminating private medicine in public hospitals could free up 2,000 hospital beds around the country and reduce waiting lists by 25%. This follows the expert review carried out by Dr. Donal de Buitléir. Specifically, the group noted that removing private activity from public hospitals is technically feasible but dependent purely on political will. Ireland has the highest proportion of private health care insurance of any European country, representing 45% of the population, according to the Health Insurance Authority. In 2018, premium income from private health insurance rose to €2.85 billion. If plans to end private medicine in public hospitals were followed through, it is suggested that private facilities and, ultimately, the demand for private insurance would become redundant over approximately ten years. These sums would then be freed up to be invested in quality, single-tier public healthcare systems. Will the Taoiseach confirm if he intends to push through these reforms to eliminate private medicine in public hospitals?
Last Tuesday, I was asked to go to an emergency meeting of parents of children in a crèche, the Magic Roundabout. They were already paying €1,100 in monthly crèche fees, which I find staggering. Those fees will go up to €1,250 a month while 20 of the parents will lose their kids’ places in the crèche. This is because Tusla told the crèche it needed to make changes, which it did. Tusla then came back and stated that because of the changes made, the floor space was reduced and it would have to get rid of 20 of the kids. This is in the middle of the term. It is unbelievable.
This is against a background where 27 crèches are threatened with closure and parents are saying they have been left in the dark about these matters. Parents are flabbergasted, shocked and do not know what to do.
In the case in question, the parents have asked for a meeting with the Minister for Children and Youth Affairs, Deputy Zappone, to discuss the matter. I must stress that if there were any health and safety or fire safety issues, these parents would be the first to say something must be done. What is not acceptable, however, is the sort of ham-fisted, box-ticking, blunt-instrument approach that appears to be taken by Tusla in terms of crèche facilities, compliance and so on. The big point the parents in this case made was how can one bring in a scheme for two years of free preschool care in the ECCE, early childhood care and education, scheme but not actually provide for the places, particularly considering the shockingly high levels of costs parents must endure.
Will the Taoiseach comment on that? Judging from the attitude at the meeting, there is an explosion on the way on the issue of childcare costs and the lack of childcare places.
I thank Deputies for their questions.
Deputy Burton raised the issue of undocumented minors living in Ireland. From time to time, we introduce schemes to regularise undocumented migrants in the country. This is not an amnesty. It has been agreed at EU level that there will not be amnesties. That is part of our commitment to our European partners. Any time we have a scheme to regularise undocumented migrants, we always need to consult with the United Kingdom because it has an impact on the common travel area.
Within the confines of the common travel area and the EU pact not to have any amnesties, we do from time to time have schemes to regularise migrants. The one we had recently was a scheme to regularise people from outside the European Economic Area, EEA, as well as their dependants, who came here on a student visa but became undocumented for one reason or another. That just finished up this year. We regularised 2,000 people under the scheme and it worked well.
It is a useful scheme for me when I go to the United States because I can then say in Congress and the White House that we are not asking the American authorities to do anything for our undocumented there that we have not done here in Ireland. If the US were to copy our scheme, essentially it would provide a pathway to regularisation to anybody who came to the US on a J-1 or a student visa and who became undocumented there.
The other group, referred to by Deputy Burton, we want to look at next is those who came to Ireland as children and know no other home than Ireland. They will not be deported. They never really lived in the country in which they were born or, in some cases, the country in which their parents were born, as some of them were born in Ireland. We need to get these arrangements right and ensure they are properly organised. We must ensure it cannot be abused or undermines our commitments to the European Union or to the common travel area. I have met some of those young people, as has Deputy Burton. They have grown up here and speak with Dublin, Cork or Donegal accents. They will not be deported. It will be correct to regularise them but we just need to get it right. We got it right for the students. We can get it right for those who Americans would call dreamers.
The policy of universal healthcare is to provide free or highly subsidised healthcare for all. There are many models across the European Union under which that can be done. There is often an assumption in Ireland that the NHS is the system they have across Europe. It is not. Every country has a different public health system. Sláintecare does not prescribe which model we should follow. It refers to co-payments, free services and many other matters. It must, however, be done step by step.
We have made much progress already on GP care. Nearly half the country has access to free GP care. That will be extended to children aged seven and eight years of age next year, having extended it to those on lower incomes by increasing the income limits this year and to carers the year before. We are also reducing prescription charges for those with medical cards and those who do not have one. By reducing the drugs payment scheme, DPS, threshold, that will continue. We are extending eligibility for medical cards. One of the first things the Fine Gael-Independent Alliance Government did was to give medical cards as a right to children with serious disabilities, regardless of their parents’ income. Under previous Governments, they were often subject to review. Children with serious disabilities could lose their medical cards because their parents’ incomes went up. That does not happen any more. Any child in receipt of domiciliary care allowance, DCA, is also entitled to a medical card, regardless of his or her parents’ income. The next change will be around improving the income limit for the over-70s to ensure more people over 70 can contribute.
The thresholds have stayed the same. The reason why the numbers have gone down is because incomes have gone up. That is the reason why the numbers have gone down. I would have thought most people would believe that is a good development.
The fair deal is a form of universal healthcare with co-payment systems. We need to do something similar around home care. We are also examining hospital charges as a possible further step. It is not something one does in one go but over a series of budgets. We are making some progress.
Deputy Micheál Martin asked me a fair question on when the number of people living in emergency accommodation and the number of homeless people will go down. The truth is I cannot answer that question. I can tell him that we have taken more people out of homelessness in the past year than ever in the country’s history. The numbers becoming homeless is roughly the same, however. That is why the numbers have been roughly the same for the past year or so.
The drivers of homelessness are different ones. It is people losing their private rented accommodation but also people experiencing family breakdown. There is no reliable way to know how many people are going to become homeless. We can know how many people we are going to stop becoming homeless when they come to us or the numbers we can get out of emergency accommodation. We have never taken more people out of homelessness. At the same time, as many people become homeless, and there is no way of predicting that for sure.
It is worth putting on the record that in the year before Rebuilding Ireland was introduced as our policy, the numbers of families who were homeless increased by 60%. In the past year, the numbers of families who were homeless increased by 0.17%. That shows the difference Rebuilding Ireland has made. It has not got the numbers down yet but before Rebuilding Ireland, homelessness was rising by 60% a year. In the past year, it has only risen by just over 0.17%.
We are meeting our targets in social housing.
The special adviser to the Minister for Employment Affairs and Social Protection, Deputy Regina Doherty, is a secondee from another part of the public service. As is the norm when somebody is seconded from one part of the public service to another, they stay on the same salary.