Wednesday, 24 November 2021
Ceisteanna - Questions
I propose to take Questions Nos. 5 to 11, inclusive, together.
The Cabinet committee on health oversees implementation of programme for Government commitments on health, receives detailed reports on identified policy areas and considers the implementation of health reforms, including Sláintecare. The Cabinet committee last met on Monday, 8 November. It is intended that it will meet again shortly.
In addition to the meetings of the full Cabinet and of Cabinet committees, I meet with Ministers on an individual basis to focus on different issues. I meet regularly with the Minister for Health to discuss priorities in the area of health, including Sláintecare and especially our management of and response to Covid-19.
The health sector is expecting to face significant challenges this winter. The recently published winter preparedness plan 2021-2022 is structured around three key goals: avoidance of hospital admittance, unless absolutely essential; patient flow through our hospitals; and safe and timely egress of patients from hospital. The Government is investing €77 million in this year's winter plan.
It is important to recognise that €400 million from last year's winter plan has been retained and was locked into the regular annual funding base for 2022.
I thank the Taoiseach for the outline. I want to ask about the Government's spending on temporarily renting private beds in private hospitals. The Labour Party has continually advocated for expanding public healthcare by purchasing private hospitals outright. We are conscious that with the Covid plans, the Government essentially, at one point, took over full capacity of the private system. We now have this arrangement for leasing. We know that this arrangement cost the taxpayer €350 million between March and June 2020, and that a deal is currently in place with private hospitals should there be a need for them to manage capacity. How much is being spent on this temporary renting out of private beds in private hospitals? We have argued that the money would be better used to permanently expand our public capacity in a bid to tackle our ever-growing waiting lists, which we are all conscious of, our ageing population and the ongoing, devastating battle with the Covid pandemic.
Sláintecare calls for the building of three elective hospitals. This part of Sláintecare is essential to deliver the massive, radical reforms that out healthcare system so badly needs. It would surely be much better and more efficient to use the resources already available, by buying the hospitals to fulfil that key Sláintecare recommendation to support our healthcare service through the pandemic and beyond. We know 50% of the population has private health insurance. This expense is built on a fear that the public system will not be able to care for us and will not have the necessary capacity if we fall sick. Looking at European neighbours and at how other countries are coping with Covid, we think that now would be the best time to prepare our healthcare system. I ask the Taoiseach about the spending on private beds.
In response to my colleague, Deputy Pearse Doherty, two weeks ago, the Minister for Foreign Affairs, Deputy Simon Coveney, stated unequivocally that the families of the victims of abuse at Ard Gréine Court in Stranorlar, County Donegal, deserve to get the full truth and to see the full Brandon report; not an executive summary or an extended executive summary but the full report. Leaks of this report to the media tell us that there were 118 occurrences of sexually inappropriate behaviour, which impacted 18 victims, all extremely vulnerable individuals, many of them non-verbal. As Deputy Doherty has highlighted time and again, the families of the victims placed their trust in the centre and the HSE to protect their well-being and safety. This trust has been broken in the cruellest and heart-breaking of circumstances. It was, as is so often the case, the courage of a whistleblower that led to investigations into the abuse by the Health Information and Quality Authority, HIQA, and An Garda Síochána. Two years after that, the abuser was relocated and the abuse started all over again. Deputy Doherty wrote to the former Minister for Health in 2016 to raise the issue of under-reporting of abuse at the facility. He was told by the then Minister, Deputy Harris, that it was a matter for the HSE. We are here many years later and the HSE and Garda are blocking publication of the full report, the two State agencies responsible for protecting victims in the first place. I share the view of Deputy Doherty and the Minister, Deputy Coveney, that political input is needed to ensure that the unvarnished truth is published. This needs to be transparent. I ask the Taoiseach to ensure that there is urgency and that the victims' families have full sight of this report.
The Tánaiste has now raised the possibility that the Government decision on antigen testing might be delayed until the Cabinet meeting next Tuesday. Does the Taoiseach think this is an acceptable delay? It is 20 months into the pandemic, with more than 5,000 cases on some days, yet there is no action from the Government on this issue. Can the Taoiseach argue with my contention that the more antigen testing is done, the better it is from a public health point of view, and that more testing is likely to happen in the event of the tests being made free? No PCR tests are available in Cork today or tomorrow for anyone applying now. It is the same in 13 other counties. The HSE says that 210,000 tests were done last week. I understand that the laboratories and the test and trace system are coping, but we do not have enough swabbers. I put it to the Taoiseach that we failed to anticipate and put measures in place for this situation. What measures will be put in place now?
Elective hospitals for Cork, Dublin and Galway were mentioned earlier. Government Deputies told the The Echothat there would be an announcement about this in the first week of October. We are now coming towards the end of November. When will we get an announcement about our new elective hospital?
Yesterday, I said to the Taoiseach that people cannot get a PCR test in Dublin for love nor money. Now that fact has been confirmed, although people in the Government's front bench were shaking their heads when I said that. Something else that the Taoiseach might consider is that, if people cannot get a test for a couple of days, they can understandably feel pressure to get a private test, which can cost up to €99. They can go to private hospitals to get a test and pay for it, which underlines the point about how unacceptable a two-tier system is when we are talking about the lack of capacity in our system. It is not just about the ICU and beds but the ability to test. If a person has €99, he or she can pop up to the Beacon and be tested today. That is the reality of what a two-tier system provides when faced with a public health emergency. All that Covid has done has highlight the inadequacies that exist with the two-tier system. We have an ongoing public health emergency with waiting lists and emergency departments. It is unacceptable on the issue with testing. The Government will not provide pop-up centres, which we asked for yesterday. If we nationalised the private healthcare capacity, we would be able to test people as quickly and urgently as we need them to be tested.
When will the Cabinet committee on health next meet? Will there be an opportunity to discuss the well-being framework? It is a positive initiative which focuses on quality of life and a range of issues. The initial report was published months ago. As we make our way through the pandemic, there is a greater need than ever to focus on various aspects of our life, including mental and physical health and much more. Unfortunately, maintaining physical and mental well-being, and so many other things, slipped off the radar when people were isolated, including carers and people they care for. We see much more of this in mid Cork and it is a worry. The HSE has identified a need for a daycare centre for older people around Macroom. It has identified an ideal site for on the hospital grounds. It would present an opportunity for older, isolated people, a break for carers, social interaction and access to various therapies and supports. While the HSE has identified a site, it is hard to see progress on it. Will the Cabinet committee on health meet shortly? Will it discuss the framework for well-being? Will that framework give additional energy, priority and focus to those waiting for a day centre in Macroom?
I raise an issue that I have probably raised countless times in my five-and-a-half-year tenure here. It is about access to medicinal cannabis. I do not give the Taoiseach too many compliments, but I will give him one. I know he personally got involved in a number of cases in the past, which is to his credit, because this issue sometimes transcends politics. I have some good news. In the next week, three people will be registered and will get prescriptions under the medical cannabis access programme. That is very good news because that could be transformative for those three people, since they will get legal access to medical cannabis via prescription. That has been a tortuous road to get access.
That is good news.
Many of the people who contact me and others, including campaigners and families, want to know how they can get medicinal cannabis for their loved ones. I understand there are criteria in regard to the stipulations and conditions under the programme, but many people are extremely frustrated in regard to access. Some people have to go abroad and, even worse, some people have to do without. I have seen the impact on people of having to go without, in particular those whose children are in pain. It is terrible. I have also seen how this medication can be absolutely transformative for people's loved ones. I am pleading with the Taoiseach to make this programme work for the countless number of people it could benefit.
I thank all of the Deputies for the issues raised under this heading. Deputies Bacik and Boyd Barrett raised the issue of private healthcare. In an emergency and in a pandemic, it makes sense to use all capacity that is available within the country. In regard to the first deal, I was not in government then but, to be fair to everybody, it was entered into in the uncertainty of the first wave of a pandemic and it was not, perhaps, utilised optimally. It was a huge cost. In terms of what has happened since, the HSE has entered into a more sustained agreement with the private sector, but I do not have the exact cost here. It is a type of safety net programme, with up to 1,000 bed days per week currently being utilised and a plan to increase that to 3,000 per week given the pressures on the public acute system because of Covid-19.
It is important to point out that this year has seen the largest increase in the provision of beds in our public health system, with approximately 950 hospitals beds to be in place across the system by the end of this year. The number of ICU beds has increased from 255 in 2020 to close to 300 now, and it is hoped to expand that further. There is a clear programme of expansion of public sector health provision and capacity. There is a whole range of work still to be done in terms of the consultant contract issue and other issues. Meanwhile, the idea of nationalising other hospitals is not on the agenda, nor is it possible. We cannot just rock up and buy a hospital if there is no vendor.
As we expand the public health sector, it has to be integrated into our existing structures. In terms of the elective facilities mentioned, they are public elective facilities that have to be integrated into existing acute hospital systems within given regional areas. The relationship, for example, between an elective facility in Cork in terms of Cork University Hospital and the Mercy University Hospital and others is key. That has to be part of the wider public health provision and giving access to public patients. Likewise in Galway and Dublin, where elective facilities are being planned for. The Department of Health is working up proposals in respect of facilities in those locations.
I do not have the exact cost of the current programme but my understanding is that it would have been discussed in committee prior to this wave because it was been in place for most of this year. It is increased as pressures increase on the public system. The overarching objective is to increase investment in the public system. That remains the overarching priority.
In regard to the inquiry in terms of the appalling situation that occurred in Stranorlar and the terrible reports which we have learned about there, Deputy McDonald stated that the Garda is stopping the publication of that report. An Garda Síochána is the authority in this country in terms of the law and prosecutions to criminal law. Ordinarily, Government does not intervene and tell the Garda not to pursue something or to abandon its investigations. I believe in the full truth being known and that the report should be published. My understanding is the Garda is indicating that full publication could jeopardise its investigatory process. Ultimately, the report has to be published. The families of all those who have suffered need to be given the full information in respect of this case. It is a shocking situation.
On Deputy Barry's question, transmissibility of the Delta variant is enormous across Europe. Fortunately, we have had one of the better vaccination programmes, with 93% of our population fully vaccinated, which is protecting against severe illness. Other European countries that are at 65% and 70% are experiencing a real problem now with the unvaccinated ending up in ICU. Last week, over seven days, 210,000 were vaccinated. That is not an inconsiderable number of vaccinations. That should be acknowledged. We have to do more. We have to increase capacity and we are going to do that. In addition, we have expanded the use of antigen testing significantly in the past six months, both in terms of various sectors such as the food production and healthcare sectors and in terms of close contacts, in respect of which up to 60,000 free tests were provided and a further 100,000 were provide to the agriculture sector.
I did. The Department is working up proposals. I do not have a specific date.
Deputy Boyd Barrett raised the issue of the private hospitals, which I have dealt with.
Deputy Aindrias Moynihan asked about the well-being framework. The Department of the Taoiseach is overseeing the development of a well-being framework. It is along the lines of the late Bobby Kennedy's approach that we cannot measure everything in life by GDP and that we do have to look at well-being metrics that dictate how well a country is doing and how a society is doing for its people. New Zealand and other countries have adopted such a well-being framework.
With regard to the day care centre in Macroom, it is the type of opportunity that gives quality of life to people in rural locations. We need more of those in terms of the community side of healthcare.
Deputy Gino Kenny raised the issue of medicinal cannabis. I accept the Deputy's point that this is torturous and that the issue of access to the medicinal cannabis programme has been going on for years. I am glad to hear from the Deputy that three people are now registering. I will pursue the matter with the Minister for Health and his Department in respect of greater access to that programme and fewer hurdles such as those we have all been jumping through on behalf of people for so long.