Wednesday, 24 March 2021
Ceisteanna ó Cheannairí - Leaders' Questions
We again find ourselves at a crossroads in our long fight with Covid-19.
After three months of living under level 5 restrictions - our third lockdown of this pandemic - people are understandably fed up and many of them are angry and frustrated. Thousands have not seen a day's work in a year. Many have not seen family or friends in months and small businesses are either closing or struggling to survive. It is fair to say that people have made huge sacrifices to suppress the virus following the dangerous position we found ourselves in after Christmas. However, infection rates remain very high. NPHET has warned that we are in a very "volatile and precarious" position. People are now anxious about the possibility of a fourth wave. They are worried about the prospect of a lost summer after months of slogging it out with this virus.
We are now approaching 5 April, the date the public had hoped would bring some relief from restrictions, yet people are still waiting to hear the Government's plan as to what lies ahead. Instead of clear communication and strong leadership, what we have had throughout the crisis is mixed messages and kite-flying. To say that people are at the end of their tether is in many cases an understatement. They have seen the Government fail to do what needs to be done to get ahead of the virus, to pave a pathway for a safe reopening of society. That has left many in disbelief. I refer specifically to a stuttering vaccine roll-out, a failure to adequately ramp up testing and tracing and the carte blanchethat has been given to meat factories, for example, with devastating consequences.
However, I think it is the refusal to deal with international travel that stands at the top of the list. The lack of common sense in Government policy is mesmerising. The situation is that people cannot go 5 km from their home, but they have to watch as up to 10,000 people a week arrive here from abroad, many on non-essential trips, including holidays. As early as last May, public health officials were urging the Government to implement a full and proper form of mandatory quarantine. These calls were ignored and that has left us exposed. In the meantime, thousands travelled here from other countries. Ten months later, the Government has introduced a scheme that does not go far enough. The list of 33 countries is far too limited and, in any event, only two of those countries have direct flights into Ireland. We have a half-baked plan that leaves us vulnerable to importation of the virus and to further dangerous variants, the threat from which was keenly highlighted in NPHET's most recent letter to the Government last week. We need a system of real mandatory quarantine for all non-essential arrivals from all countries. That is the only approach that will get the job done. It will send a message to international travellers that now is not the time to come here.
The situation in relation to the virus is very fragile. I recall when I came in here early this year we had 42,000 cases in one week and we had 2,000 people in hospital. I made it clear on that occasion that I wanted to see a consistent suppression of the virus. In the past seven days we had 3,800 cases and 325 or 329 in hospital. The point is that the sacrifices people have made have had an impact in getting case numbers dramatically down from the January figure and getting hospitalisations dramatically down, as well as the numbers in ICU, which are currently at 76. That needs to be said. The level 5 restrictions have worked effectively to bring numbers down very significantly from where they were. That needs to be acknowledged. People need to know that and not to be given mixed messages by the Opposition which consistently tries to blur the facts. The numbers are still relatively high compared to the first and second waves. The fundamental reason for that is we are dealing with a variant that is highly transmissible and more dangerous. That is the context. We have been very clear that increased mobility can be a factor in facilitating the spread of the variant. That is why we are currently in level 5. I have been very consistent in saying publicly and in every forum that no decision has been made on the post 5 April situation. We will be engaging with the public health advice and other research regarding this.
We acknowledge the enormous stress, strain and difficulties the current lockdown is imposing on people in terms of the restrictions on their personal freedom and liberties, keeping within 5 km and not meeting up with others. The reason for that is we do not want to go back to a situation where we have 2,000 people in hospital or 42,000 cases in a given week. That is what we must avoid. The variant is essentially a new virus in terms of endeavouring to contain it. That governs how we will approach the phase after 5 April. I am watching other countries such as Czechia, France, Germany, Slovakia and a range of countries in Europe where the trajectory is upwards. Ours is flattening but it has gone back up in the past seven days. That is something we need to very seriously take into account.
We are the first country in the European Union to introduce mandatory hotel quarantine. I assure Deputy McDonald that I want to try to develop a united front here, but she was encouraging people and pressing the Government to facilitate travel at Christmas time. She said that publicly. She had her own definition of what constituted essential travel. Up to quite recently she said mandatory quarantine should be for non-essential travel, which misses the point about mandatory quarantine in the first instance, because once one has mandatory quarantine it is designed to-----
Recommendations will come from the Chief Medical Officer about adding other countries. We are the first in Europe to introduce this and that should also be acknowledged.
The situation is fragile, and that fragility is undoubtedly added to by the reality of increased variants. The question that arises is how we get from under this, how we carve out a pathway where we can reopen safely and where society and the economy can remain open. It is very clear at this stage that in the absence of adequate testing and tracing, a very efficient and safe vaccination programme and the necessary protections at ports and airports, we will not be in a position to reopen in a way that is safe and can be sustained.
Let me return to my question which essentially revolves around mandatory hotel quarantine for all non-essential travel. The Government has taken a half measure and half measures will not cut it. The fragility and danger of this situation have been amplified again here today.
I think the Deputy needs to define what she means by "non-essential travel". At Christmas time, she said that people who were coming home to meet their parents was essential travel. She needs to come clean with the people in terms of what she is actually saying about this.
We are bringing in mandatory hotel quarantine. Countries will be added to the list by Government, as recommended by public health, in addition to the 33 countries that are on the schedule 2 list. That is in addition to a range of other measures we have taken, including the obligation to have a negative PCR test, mandatory home quarantine, which has been a legal imperative for the past number of weeks, non-essential travel incurring fines, police checks at the airports and so on.
Vaccination is the key factor in dealing with the virus, and, to date, more than 700,000 doses have been administered in the country. We are looking forward to higher supplies in April, May and June.
There will be a significant number of vaccines administered in addition to what we have done, which has been very effective in bringing down the levels of disease.
While Covid is front and centre in people's minds, which is very understandable, other issues are not getting the attention they deserve. One is the jaw-dropping decisions being taken on housing. I want to focus on one of those, namely, the long-term leasing of social housing. Incredibly, social housing is now being actively sold as a financial product. One website states:
There is no requirement to deal with tenants, as local councils (or housing agencies) are your lessees. This is a hands-off situation with no risk of vacancies or the usual tasks associated with managing property lets. The cash comes directly from local government into your bank account, there is no intermediary. Build a portfolio of approved social housing units, houses, and apartments that will be rubber stamped by local councils and housing agencies for long-term leases. Sleep peacefully without worrying about stock markets! Your obligations stop at buildings insurance. There is no local property tax when leases are over 20 years.
This model effectively means developers build housing estates and rather than the State purchasing 10% for social housing at cost price, the properties are leased for 20 or 25 years with a four-year rent review. Houses are refurbished at the end of the lease and handed back to the developer, and presumably the tenant is then chucked out.
The dominant means of delivery of social housing is now Part V and it is increasingly and, in some areas, exclusively delivered through long leasing. Are councils obliged to accept leasing if offered under Part V? Do they really have a choice? The Minister for Housing, Local Government and Heritage has stated on the record of the Dáil that it is up to local authorities to decide, but it seems to be a take it or leave it scenario.
I have been told in the House that there has been no change in policy. I have to ask whether the Dáil is being told the truth or are we being misled? In addition, there is little transparency regarding the process in the planning files. Thousands of these tenancies will be in place before people realise they are being taken for complete fools.
An example given on hobbsfinancial.ieis a two-bedroom apartment in Dublin 8. It is stated that the investment, including all acquisition costs, is €290,000 and after 25 years the investor would have earned a rent of €520,000, a profit of €229,000. That is, of course, courtesy of the taxpayer. It goes on to state that the investor will have a refurbished property and no property tax obligations. There will be thousands of these. This may not be a product of Taca or the Galway tent, but it is right out of the same playbook.
Has the Government examined the cost of this? Has it considered it from a societal perspective? What is the Taoiseach's view on social housing being sold as a financial product? Will he change that policy?
The broad thrust of Government policy on social housing is to build social housing. We have taken a suite of initiatives. The bulk of construction next year in terms of the provision of social housing will be through approved housing bodies, AHBs, which have consistently been building social housing on behalf of the State, but also the councils. Direct builds will comprise the large bulk of social housing output, where councils, along with AHBs, commission, provide and allocate housing. The majority of 9,500 units provide last year were constructed.
However, number of other mechanisms will be used. The Minister is clearly of the view that the majority of provision has to be through councils and AHBs, while also getting involved in affordable housing. We have to dramatically increase the number of social housing units we make available through direct build, Part V and other mechanisms. In many respects, that will remain our emphasis and focus.
We will pursue a number of avenues. We will continue to review them, in particular the cost-benefit analysis, what is most advantageous from the taxpayers' perspective and what provides long-term value for money. We need more activity in the marketplace and more social housing provision than we have had over the past number of years. That is what the Government is committed to doing through a number of schemes and mechanisms.
In the initial period, leasing has been one of those options to create quick access to properties, in particular in addressing homelessness during the Covid phase. We believe that there is an opportunity in the context of Covid to get the homelessness figures down and have more permanent provision of housing, in particular for single people who are homeless, which is a significant proportion of those who are homeless.
Social housing will predominantly involve councils and AHBs commissioning the building of local authority and social housing. That is the broad thrust of policy.
I accept that building needs to happen more quickly and output needs to increase. I do not think we disagree about that. That is not the issue I am trying to raise. I do not see the evidence on the ground. Housing is the number one issue I hear about on my phone, and has been for the past ten or 12 years. I am acutely aware of it.
This is the most expensive and least satisfactory way of delivering social housing. Social housing is now a financial product.
I see no evidence on the ground of scaling up. I see turnkey and long-term leasing in terms of how housing is manifesting in my area. Increasingly, I am seeing that in some of the Dublin local authorities. Is the Taoiseach certain about what he is telling is? Has there been a shift in policy because I am only seeing turnkey and long-term leasing? Increasingly, it is long-term leasing with a council being told to take it or leave it. It is being actively promoted by the Department.
Approximately €3.3 billion has been provided for housing, a 24% increase on budget 2020. Clearly, in the first three months of the year Covid has restricted output. That is obvious, because of the level 5 lockdown and our decision to reduce mobility. That has had an impact on the first three months of the year.
The €3.3 billion available is the highest investment in housing by any Government in a single year. Some €500 million in additional capital has been provided for the delivery of 12,750 new social homes for people on the social housing list. That is positive.
Of that, 9,500 will be direct builds. The Deputy has picked one particular scheme, which represents a minority of what will be provided, and presented it as the main plank of Government policy, which it is not. The main plank is 9,500 of 12,750, which will be new builds through approved housing bodies and through local authorities. I agree that we need to get output up and we have to use as many mechanisms as we can to get output up for social housing.
With the roll-out of the vaccine against Covid-19 under way, plans have been put together for how and when people will be given the vaccine. Plans have also been drawn up so that schools can fully open in the very near future and for when restrictions on business and social interactions might be eased or lifted, but the plans that I have heard little about are those for how our health system will return to some kind of normality. Thousands of elective surgeries have been put back and cancer screening services disrupted while our hospitals struggle to cope with the wave of Covid-19 patients. That has left the entire health system with a huge challenge going forward. Latest figures show that almost 900,000 people are on the waiting list for treatment in hospitals in Ireland, an increase of almost 12% on this time last year. Of those, more than 600,000 are waiting for their first hospital outpatient consultation. Shockingly, more than 280,000 of those have been waiting for a year or more to be seen for their first appointment. That is even more than the number of people who have been waiting at least a year for hospital treatment with the NHS in England, serving a population 11 times greater than that of the Republic of Ireland. In England, 5% of the total number on the waiting list have been waiting a year or more; in Ireland that figure is 45%. It goes without saying that Covid-19 is not entirely responsible for this but the pandemic has turned what was a crisis in our health service into a disaster. We are not just talking about figures. Every one of these people is a mother, father, son, daughter, sister or brother who, in many cases, desperately needs help to ease pain and suffering. Bringing hospital services back even to the so-called normal levels of pre-Covid times will be an enormous and costly task. According to the ESRI, it could cost more than €1 billion to clear the hospital waiting list caused by Covid-19. Regardless of the cost, it simply cannot be delayed. A task this huge requires the establishment of a special task force that would identify what needs to be done, come up with a plan of concrete action and have real power to clear any obstacles. Private hospitals should be commissioned to play their part in the recovery in the same way they were brought in to help the country handle the early wave of the Covid-19 emergency.
What are the Government's plans to restore vital hospital services and clear the record waiting lists? Will it employ the services of the private sector in doing this? Will it Government agree to establish a task force to oversee the recovery of our health service that is causing so much pain and anxiety.
I thank the Deputy for raising this important issue. Covid has caused unprecedented interruption to normal healthcare activity, with both community and acute settings affected. It also created extra pressures on the provision of cancer services, not only in Ireland but globally, because of the additional demands that treating patients with Covid has imposed on the health services and also the wider impact of Covid. The Government has asked the HSE to implement new pathways of care where services can be delivered in line with demand and in parallel with Covid care. Cancer services, for example, have continued throughout the pandemic in line with the national action plan on Covid-19 and the national cancer control programme is continuing to address backlogs and provide information to cancer patients on Covid-19. This year, overall GP referrals for weeks 1 to 10 amount to 110% of 2020 activity; breast referrals are very high at 122% of 2020 activity; lung is 64%; and prostate, 56%. Despite the Covid challenges, the number of Covid patients with symptomatic breast disease seen at clinics amounted to 88% of the 2019 figure. Surgery numbers to the end of November last are at 77% of the 2019 level. The number of patients receiving chemotherapy is at 88% of 2019 levels and radiotherapy is more than 90% of 2019 levels. Additional funding has been allocated, close to €500 million, to permanently fund 2,600 beds in acute and community settings and another €52 million for critical care beds, which will help to deal with waiting lists into the future.
During the second and third Covid-19 surges, more services remained open than in the first wave, demonstrating how we have adapted as a health service. The HSE is implementing a plan for the prioritisation and restoration of services. It is informed by data modelling undertaken by the HSE integrated national operations hub and is in continued alignment with guidance provided by NPHET. Phase 1 is March to June, phase 2 is July to September and phase 3, October to December. We provided an additional €240 million for an access to care fund, €210 million of which has been allocated to the HSE and €30 million to the National Treatment Purchase Fund, NTPF. That allows for treatment in both private and public hospitals to address capacity issues in acute hospitals and waiting lists. The NTPF is working with public hospitals to arrange treatment for clinically suitable patients and as of the end of February, more than 4,000 day case and in excess of 2,000 GI scope offers of treatment have been accepted. For outpatients, the NTPF had arranged 3,464 appointments by the end of February.
The safety net arrangement with all 18 private hospitals will continue and will be used to deal with the backlog and outpatient appointments.
The hospital with the highest number of people waiting for an outpatient appointment is Galway University Hospital with more than 54,000. It also has by far the highest number of inpatient or day cases waiting at 9,500 people. The biggest problem is the backlog of orthopaedic patients and people seeking help for painful hips and knees that need replacing are being told it could take up to three years before they are seen for initial assessment. I am glad to learn that work is to begin within weeks on the long-awaited second operating theatre for orthopaedics to replace the one that closed in 2017 but it will be a long time before it is operational. I urge that special action be taken in the meantime to clear the exceptional backlog in Galway that is causing so much pain and anxiety to so many.
I will pursue the Galway situation with the HSE. While we are waiting for permanent capacity to come in place, it is important that other interim capacity measures are taken to deal with that backlog, particularly in orthopaedics as well as other areas. That is why the more sustained contract with private hospitals gives the HSE options to deal on an ongoing basis with a range of services where there are backlogs and where works are on the way to give more permanent capacity in the public system. Significant capital works are under way. The service plan provides nationally for an additional 16,000 staff above the December 2019 levels. That includes more than 1,100 medical and dental staff, more than 3,500 nurses and midwives and 4,000 health and social care professionals. A significant expansion is provided for both in current funding for the health service, way and above anything in previous years, but also capital funding to increase capacity as quickly as we possibly can in surgeries, operating theatres and beds generally.
I wish to ask the Government to open up construction for all those who have not been working for the past four or five months. I wish to ask the Taoiseach respectfully to increase the numbers who can go into a church for a funeral mass. I ask him to take into consideration size and height and capacity of places such as cathedrals and big churches and to increase the numbers.
Fr. Gearóid Walsh was on our local radio last week and he said that we have a professor for everything, but no professor or position has been created for a person with common sense. I sympathise and empathise with the McCarthy family from Gneeveguilla, and particularly with Mr. Jack McCarthy who lost his wonderful wife, Mary Theresa, yesterday. There are around 100 members of that family. I do not know how they are going to manage, but I do not envy the person deciding who the ten people to go to the funeral will be.
I want to go on to construction. For too long now some construction workers cannot go to work. Those involved in social housing can go to work. It is very galling for some people, when Tim can go to work, but Tom and Mike cannot go to work because they are not working in social housing. Not everyone is able to get on the social housing list and people need houses. Some people want to build their own houses and they should be allowed to finish them.
We have to recognise that English recruitment companies are looking for skilled workers of all types, including carpenters, plumbers and drivers. Flannery Plant Hire is advertising every week for 360 degree excavator drivers and drivers of dumper trucks and different vehicles to work on the HS2 rail project in England, which is the biggest job since the Channel Tunnel. If the Taoiseach does not believe me, he can get the Tánaiste, Deputy Varadkar, while he still has him, to look on Twitter - he good on Facebook - to check all that is happening in that line. Surely they should work together and see that, and they are looking for women as well in case that the Minister of State, Deputy Madigan, is listening in to us. You see-----
I thank the Deputy for raising the issue. In his overall presentation, he was essentially dealing with the negative impact that Covid-19 has had on all our lives, including in such areas as attending mass or other religious services, in construction and in other areas of life. The virus has upended our lives. It has not been the Government, the Dáil or the Oireachtas, but the virus. The problem now is that we have a virulent form of that virus in the B.1.1.7 variant, which is the dominant variant in the country. We need to be very careful in how we deal with that variant in respect of restrictions etc.
That is why in the next number of days we will spend much time talking and getting the epidemiological data. I am conscious that in the last several days the numbers of cases of Covid-19 have gone up, bar yesterday. Everybody in this House needs to take that on board and interrogate it. It is serious. We are rolling out the vaccination programme and we will have far more vaccines in the second quarter. Over 700,000 doses have been administered now and that is an important point. As we move through April in particular, we will have far more people vaccinated.
On funerals, I understand and accept fully the sincerity of the Deputy's presentation. I think it is terrible myself. Not being able to attend the funeral of a loved one is the one aspect of Covid-19 which hits people the hardest. The numbers of people who can attend funerals are very low. We will look at that. We have been asked by the churches to look at it. I am not giving any commitments or guarantees in relation to it because we want to protect people. Unfortunately, some events at some funerals, a minority, have led to a spread of the virus, not in the churches, it must be said, but at subsequent events. There have been very significant outbreaks related to funerals, unfortunately. Hence, the extreme caution and the regulations which have been put in place relating to funerals.
On construction, the evidence was that general mobility will give rise to the spread of this variant. I remember back in January when we had 2,000 people in hospital. At that time, everyone here was into suppressing the virus, into zero Covid and the prevailing mood in the Chamber was let us never open again given the extraordinary pressure that was on our hospitals and front-line healthcare workers. I did say at the time that I knew it would not be too long before Deputies would be coming back saying we should open this and that. I understand that, but we are dealing with a very transmissible variant and that is something we need to take on board. It is not the Government or anybody that is trying to stop people going back building. The Government wants a housing programme. It is our No. 1 priority for us socially in respect of building more homes, but this virus, and this variant of it, is upending the best laid plans and most of all the quality of people's lives.
I respect the problem that the Taoiseach and the Government has. The problem though is we are not getting the figures down and if that is to continue, the Government will have to be sensible and allow sectors of the community to open and to work. The Government must trust people. People working on farm buildings can keep away from each other, as can people working on building a rural one-off house or a small estate.
Other groups, such as small traders and shopkeepers, are also under severe pressure from multinational companies trading online. They will never be able to open up if this thing goes too far, and I am afraid that it is. Let us take hairdressers as an example. When they were allowed to open, they were very careful to just allow one person in at a time. We must be sensible and trust people to work. If this continues, I do not know who or what is going to pay for it. Are we going to lose all our workers to England?
There was one week in January when we had 42,000 cases, in one seven-day period, and 2,000 people in hospital. In the last seven days we have had approximately 3,800 cases and today we have about 329 people in hospital. I ask the Deputy please to stop saying that the figures are not coming down. That is killing people saying that. It is telling people that their efforts are not working. The efforts and sacrifices that people have made have worked against a very virulent, dangerous and transmissible virus. We have got the numbers down quite dramatically because of our efforts. Meanwhile, we are also vaccinating more and more people. We have vaccinated the most vulnerable in our society, which is also working. Serial testing in nursing homes is yielding a positivity rate of 0.18%. That is how much the vaccines are working where they have been administered. It is likewise with our front-line healthcare workers, where the vaccines have also worked. That is the parallel process on which we must work.
Believe me, I understand fully where Deputy Danny Healy-Rae is coming from. Economically, however, it has been proved all over the world that the more effort there is to try to keep pressure on the virus, the better will be the result in the medium to long term. The variant is a real problem. That is all I am saying to the Deputy. This variant just takes off, if it is given a chance.