Tuesday, 17 November 2020
Ceisteanna - Questions
I propose to take Questions Nos. 9 to 11, inclusive, together.
The Cabinet committee on health was established by Government decision on 6 July and it last met on 12 November. The committee is due to meet again next month. The Cabinet committee oversees implementation of programme for Government commitments in relation to health, receives detailed reports on identified policy areas and considers the implementation of health reforms, including Sláintecare. In addition to the meetings of the full Cabinet and of Cabinet committees, I meet Ministers on an individual basis to focus on different issues. I regularly meet the Minister for Health to discuss priorities in the area of health and in particular our management and response to Covid-19.
The Resilience and Recovery 2020-2021: Plan for Living with Covid-19 sets out our approach and priorities for managing and living with Covid-19 in a range of areas including, among other matters, prevention of infection and protection of vulnerable groups; health system response and resilience; and continued resumption of public service delivery, including non-Covid health and social care. It is important to recognise that many vital services have continued throughout the pandemic, ensuring that priority care needs were addressed and the most vulnerable protected even at the height of this crisis.
Winter 2020-21 will be a particularly challenging one for the health service. We recently allocated a record €600 million for the 2020 winter initiative to ensure we meet the demands in the health service in the coming weeks and months. A range of initiatives have been developed, and as these continue to be rolled out, we will see further service resumption and increased capacity across the community, including primary care; mental health; older persons; disability services, and the acute hospital system. This includes implementing new initiatives, new ways of working and ehealth solutions to keep people safe and out of the acute hospital system, for example, epharmacy, eprescribing and virtual clinics.
At the beginning of this month, a range of measures came into effect that will make day-to-day healthcare more affordable for more than 1 million people across the country. Under the new measures, the over 70s medical card income limits have increased to €550 per week for a single person and to €1,050 for a couple, benefiting up to 56,000 people. There has also been a 50 cent reduction in prescription charges for all medical card holders, which will benefit over 1.58 million people with medical card eligibility. The reduction in the drugs payment scheme threshold to €114 per month has the potential to benefit all 1.38 million people eligible under the scheme.
Earlier this year, the HSE commissioned a rapid assessment of a suicide cluster which took place in Ballyfermot last year. The outcome of the assessment was published late last month and it makes heartbreaking and alarming reading. The area considered by the assessment has had a female suicide rate three times the national average since 2015. However, it was the deaths of eight women in their 20s and 30s over a short ten-week period that prompted this assessment. Four of the women were from Ballyfermot and the others were from Clondalkin, Tallaght and Palmerstown.
The assessment notes that there was a palpable sense of fear and anxiety that these deaths would have a further contagion effect. The report sets out that underlying trauma is at the root of anxiety, depression or poor mental health for women in the area. Various examples of childhood trauma, including alcohol or drug use, mental ill health, domestic violence, childhood violence and abuse, were identified. The housing crisis was also notable for its inclusion in the challenges faced by young women and their children who experience persistent homelessness and housing insecurity. The report found that a fear of Tusla removing children from mothers is a reason women do not seek help. Young mothers living in poverty and with abuse are afraid of State intervention. That needs to change. Almost all cases cited in the report refer to domestic violence as a key issue.
The HSE is to be commended for commissioning this rapid assessment. Its purpose is not to apportion blame, but to identify gaps in service provision, protections and strategy. I am gravely concerned that there is a lack of pace in urgently delivering the resources, services and reforms that are essential to protect women and their children, despite the fact that many of the solutions are in plain sight right in front of us and have been delivered in other jurisdictions. I want this to become a matter of priority all across the Government. It should be an absolute priority for the Cabinet committee on health.
This is a process issue with the Minister for Health but what happened yesterday with regulations going to the Cabinet and then being dismissed has happened before. This is not the first time the Minister, Deputy Stephen Donnelly, has been involved. Surely we do not need to have this crazy situation in which Ireland takes off because of some half thought-out plan for health measures that is then jettisoned by the Cabinet.
I want to raise two issues, both of which the Taoiseach knows are close to my heart. The first of them is the case of John Wall. Last Tuesday, he wrote to the Minister for Health and said he would not be in a position to support what the Minister is doing. John Wall and I support the medium-term and long-term plans of the Minister for Health and I commend the Minister for a number of them. However, in the short term, and the Taoiseach knows well that John Wall is terminally ill, we need to sort out 24-month terminal illness medical cards. In fairness to the Taoiseach, he told me last week he would get this done, which is the most emphatic thing he has ever said back to me. I am begging the Taoiseach to get it done. John Wall needs this and he has worked on this.
The second matter I wish to raise is the CervicalCheck tribunal. The Taoiseach knows that is in a no-go area and at a standstill. The 221+ group, particularly Vicky Phelan, Lorraine Walsh and Stephen Teap, are not willing to support it as it is constituted on the basis of the Statute of Limitations issue, the returning cases issue and a number of other issues. I have had long discussions with the Minister for Health on this. This is at an impasse. The Minister for Health has said he will go forward with this one way or the other. That is not the right thing to do. He should resolve the issues but this cannot go on any longer. It cannot go on beyond this week and for those three individuals, it will not go on beyond this week without them making a statement on it.
I got a letter yesterday from the HSE's health business services, HBS, in response to a parliamentary question. It is the interestingly named business division of the HSE, which seems like a contradiction in terms. Why do we need a business section of the health service? This was a response to a question about the contract that was awarded to CPL for recruitment in the context of Covid-19. As the Taoiseach knows, CPL has been recruiting people from Be On Call for Ireland, nurses, contact tracers and those working in testing on rubbish temporary contracts, as I would see them. By the way, if the Taoiseach wants to know why the numbers are not going down, he might look a little bit closer at the fact that people on CPL contracts do not get sick pay and so they are under pressure to go into work. The people we are recruiting to the front line do not get sick pay. It is no wonder we have cases of Covid-19. Leaving that aside, this letter confirms that CPL went through no tendering process for the contracts to recruit for the health service during Covid-19. Rather, it was "using existing HSE Procurement Frameworks" and "a framework agreement for other recruitment services", to mention some of the jargon it employs.
This is a hugely valuable contract, although it has not been said how much it is worth. It is worth noting that in the past week CPL has been sold to a Japanese multinational company for in excess of €300 million and the two owners of CPL walk away with €110 million. To what extent has the State inflated the value of that company and the huge payout that those people are getting by giving contracts where there is not even a tendering process and where they are recruiting to the health service for rubbish contracts without even sick pay? That is a scandal, as far as I am concerned. Whatever excuse there might have been in the emergency in the early months of the pandemic, for that to continue to be the situation and for CPL to be the vehicle for recruiting to the front line of the health services in the current situation is an absolute scandal and unacceptable.
Regarding the questions from Deputy McDonald, I too commend the HSE on its analysis and study of a very worrying and deeply troubling female suicide cluster in Ballyfermot and in other areas the Deputy identified, and the multiple factors that gave rise to the issues there. I will engage with the chief executive and board of the HSE to ensure that this issue gets priority attention. The lessons from this will inform wider application of policy and engagement and intervention, because that is a significant cluster in a relatively short period. I think the Deputy mentioned ten weeks. On the lack of pace, I will put the point made to me to the HSE in that regard. There is no shortage of resources. There are other issues outside the remit of the HSE in respect of housing, for example. The Deputy also referred to Tusla, and that also needs more assessment in terms of the fear the Deputy said there was in respect of removing children from families and that could cause considerable distress. I will pursue those issues. They are grave and they need focused action in terms of the lessons to be drawn from it, and whatever additional supports are required in that locality among a cohort of women who could be under pressure should be provided across all fronts.
On the questions from Deputy Kelly, as I said earlier, I think it is very important that the issue regarding the gatherings on our streets arising from takeaway pints is addressed, discussed and brought to Cabinet, because I think it needed to be highlighted from a public health perspective. The word has to go out that enforcement will intensify regarding recurrence of this phenomenon, which has been ongoing for about two weeks, mainly in the cities, and does need to be addressed and responded to. There is existing legislation in the form of by-laws in the two cities that have been identified this weekend. The Garda is reporting that crowds are dispersing, but it felt there was a significant change in behaviour last weekend. That might have been some degree of complacency because the figures were better the previous week and people felt that perhaps we had turned the corner in respect of reducing the incidence rate. We have not; the numbers are back up. Remember, the numbers we are seeing in the past three or four days were seeded a week or ten days ago. That is of concern to us in respect of where we will be at the end of this month with numbers.
Numbers are critical. If we keep community transmission rates low, we keep hospitalisations and ICU occupancy levels low for Covid-19. That enables us to keep schools going well and keep the non-Covid related health services in particular at the levels where we want them to be. That is the objective. We are doing this to try to keep the pressure on the virus and stop it from spreading and damaging people, lives and livelihoods, as it has done since it started, and not just here but across the world. If we look at what is happening in Europe, many health systems are under real pressure in respect of their acute hospital systems and their ICUs now. Thankfully, we are not in that position. We are the third best at the moment in the incidence of cases and the impact on hospitalisations and ICUs. We want to keep it that way and we want to keep that performance. That demands all our collective efforts and people have sacrificed a lot to get here.
Regarding the situation concerning 24-month, terminally ill patients, and John Wall has been a strong advocate for this for quite some time, the Minister published the clinical report, and the Deputy said that he supported his longer - I do not think they are that long - and more medium-term ideas. The Government considered the issue last week and the Department of Health is currently examining it.
On the CervicalCheck tribunal, as the Deputy will know, the Meenan report gave rise to the need to establish negligence. That then moved on to legislation, which was passed by the previous Oireachtas. The Government has decided that it will consider this issue again next week at its Cabinet meeting, and the Minister will bring a memorandum outlining where we are in respect of the outstanding issues. It is down to recurrence. The Deputy mentioned the Statute of Limitations. We do not believe that will be that significant an issue. We think we can deal with it.
Yes. Again, the HSE was under a lot of pressure in this House concerning the need to recruit contact tracing staff and have a separate workforce as quickly as possible. The agency is being called on from all fronts in the House to do this, that and the other. I presume that is why it did what it did in respect of how it procured the services of CPL. I can get that checked, but I presume that is the rationale, because there was pressure on from all fronts to ensure we recruit and get a separate workforce in place to deal with contact tracing and swabbing and to get testing to the level where our capacity now exceeds demand. Again, we want to be ready for any further spike, if one were to happen, and to have the necessary workforce in place as quickly as we possibly can.