Thursday, 29 September 2022
Ceisteanna ó Cheannairí - Leaders' Questions
Agus muid ag labhairt anseo inniu, tá os cionn 17,000 páiste ag fanacht ar teagmháil tosaigh ó fhoireann mhíchumas leanaí. Tá an Rialtas ag fágáil na páistí seo ar leataobh de bharr córas nach bhfuil ábalta freastal ar a gcuid riachtanas. As we speak, there are 17,000 children waiting for initial contact with children's disability teams. There are 2,500 children who are waiting for and overdue an assessment of needs. As the Tánaiste knows, these are crucial assessments the families and the children involved are entitled to, but they are being failed by a system that is totally unable to meet their needs. The situation is dire. It is continuing to get worse year after year under the Government. The number of these assessments carried out by the HSE has plummeted. Thousands of children are being failed by the State and left in limbo while they wait for care they are entitled to.
I will tell the Tánaiste about one of those children. Uisneach turned 13 last month. He received his official diagnosis of autism in an assessment report this week. Uisneach is a lovely little boy who has a rare syndrome involving physical and intellectual disability. His mother first asked for an autism assessment when he was six years old and beginning primary school. He got that assessment this summer as he became a teenager, following seven long years of uncertainty and barely in time to make applications for secondary school. Due to this shocking delay, Uisneach did not receive the supports of home tuition or July provision he was entitled to. He had autism his entire life and should have been entitled to both these supports but because he did not have the formal assessment and diagnosis, he was excluded from these supports. It was only after this official assessment was completed - seven years after it was requested - that his parents were directed for the very first time to any supports tailored for neurodiverse children. Because everything is put on hold for the assessment to be completed, delayed assessments mean delayed access to supports. Uisneach will not get that time back and he will not get back all the missed supports he was entitled to for many long years. Neither will the 2,500 children who are waiting for assessments of needs that are overdue or the 17,000 waiting for initial contact.
These families are left in limbo after reaching out for support. They are being failed by the Government, and this is happening under its watch. Ministers were out this week with announcements in the budget that sound impressive on the glossy surface. When you scratch beneath the budgetary spin, however, it is clear the Government has not responded adequately to the situation. The vast majority of money announced this week is to stand still, not to speed up, the delivery or assessments, or the badly-needed services that should follow these assessments. The Government's disability capacity review made it clear the levels of funding that were required to meet the needs of children and adults across the State. The Government provided a fraction of what was required. In doing so, just like last year and the year before, the Government will fail these children and many others like them.
When will the Government will deliver the investment needed to support these children and their families? When will it provide the investment necessary to ensure that they get the fairness and respect they deserve in a timely manner, and not be obliged, like Uisneach and his family, to wait seven years to be given the supports they are entitled to from day one? Will the Government rethink the budget decision and provide the resources to meet the needs of these children and deliver on the recommendation in its disability capacity review to the effect that substantial additional funding is required?
I thank the Deputy for raising this issue. It is one that is of enormous importance to thousands of families across the country. I think all of us will know from our constituency services of cases of people and children who have had to wait a very long time for their assessment of need. I am sorry to hear of the case the Deputy raised and hope Uisneach is getting the support he needs now.
There are lots of delays in getting those assessments of need done for the children who need them. As I mentioned, this is something I am aware of from my constituency service. I met Avista, one of the providers in my constituency, on Friday last to discuss this and related issues. There are additional resources provided for in the budget that will be detailed in the HSE service plan.
It is not just a matter of money. We have seen a huge increase in spending on health and disability in recent years but money alone does not solve problems. You need to recruit and retain staff, which is a challenge here and everywhere around the world at the moment. You also need to be able to ensure your systems work well. Perhaps we need to consider a change of approach here. At the moment, you need to get your assessments of need before you get the therapies you need. However, I know people who work in the sector would state that it does not necessarily have to be that way. You could start providing therapies right away. It can be very clear that some children need therapy. The system we have at the moment where you wait for your assessment of need before you get the interventions is perhaps not the best option. Where it is obvious a child needs a particular intervention or therapy, why do we not provide that straight away? We need to provide additional resources, which is happening, and additional staff, which is a challenge. Perhaps we also need to look at the system and the approach we have taken to date and assess whether these can be improved.
What these parents want is a plan. Unfortunately, what the Government has is a Minister of State who is not forward-planning. One third of all positions in disability services are vacant yet there is no plan in the budget to deal with this. The Government was brought to court by these families and it was found the law was being broken in relation to assessments of need. That is how dire it has got, and the Tánaiste is now talking about how maybe we need a different approach. Of course we need a different approach. What we really need is a different Government that will put these children first and foremost. This cannot go on year after year. The situation is getting worse. There are 2,500 children whose assessments of need have been delayed. That is up 500. The number of assessments carried out last year compared with this year is a fraction of what the HSE was doing. The situation is getting worse.
The Government does not have a plan. People who are desperate, who do have the support they require and who have children like Uisneach who are going through their entire primary education without assessments of need and the support to which I refer are this week being given a booklet on what autism is. That is a disgrace. It is a disgrace that our Government is failing so many children in this way. These people are really vulnerable. This problem could be fixed with the right political will.
I absolutely guarantee that the Minister of State, Deputy Rabbitte, is leading the way on this and is committed to working with the Government as a whole to make improvements in this area. There are a lot of additional financial resources for disability. The total budget for the year coming is going to be €2.4 billion, with €11 million or €12 million being provided specifically to improve waiting times when it comes to an assessment of need. We accept that there is a problem and it is something we are working on. We are providing substantial additional financial resources. However, there are challenges, including those relating to recruiting and retaining staff, which the Deputy mentioned, and which are by no means unique to this country. There are also challenges with getting the systems right and ensuring that we get the therapies children need as soon as possible.
It is disappointing that the Deputy used his time to only come up with one solution to this problem, namely, his party being in government.
I am not going to impose the ultimate sanction. I ask for a little co-operation; just a small bit of respect for the Chair and what it represents, namely, the democratic process, please. Could we do the courtesy of listening and stop interrupting? We are moving on to the Social Democrats.
I have to ask what part of the term "affordability crisis" the Government does not understand. Earlier this month, we learned that house prices had surpassed their Celtic tiger peak. Never before in the history of the State have they been so high. Workers and families are locked out of homeownership, stuck in a never-ending loop of paying extortionate rents but never being able to buy a home. The housing disaster is causing untold human misery and pain. Nowhere is this clearer than in the record numbers of people who are becoming homeless. Homelessness is up by a massive 30% this year. Child homelessness has skyrocketed by 47%. Thousands of children are losing their childhoods while growing up in emergency accommodation. This is happening on the Government's watch and it is getting worse. People no longer believe the Government's promises on housing. Why should they? The reality is that under successive Fine Gael and Fianna Fáil Governments, levels of homeownership have collapsed. The share of 25- to 34-year-olds who own their own homes more than halved between 2004 and 2019, falling from 60% to just 27%. That is Fine Gael and Fianna Fáil's record on homeownership - a generation of young people who no longer hold out any hope of one day owning their own homes. None of the Government's targets on affordable housing has been delivered. Last year it did not manage to build a single affordable home, not even one. This year will not be much better. The Cabinet sub-committee on housing has been told that targets for affordable and social homes have no hope of being met. Those targets were not ambitious enough to start with.
Faced with this disaster and litany of failure, what is the Government's response to the affordability crisis? It is not to build more affordable homes or to meet its own targets. Instead, it is to make homes even more unaffordable. The Government has decided to introduce a levy on concrete blocks that will add a further €3,000 to €4,000 to the price of a home. On what planet does this make sense? Does the Government really propose to place the cost of shoddy building work and defective materials onto the shoulders of people who are struggling to buy a home? Can the Tánaiste explain? Why has the Government not directly pursued those responsible for construction defects as it promised? Why are quarries that are producing defective materials still being allowed to operate? That is what the Oireachtas housing committee was told by experts a few months ago. Is the Government going to abandon its plans to impose this unfair levy?
I acknowledge that the housing shortage is an enormous challenge facing our country and people of all age groups, but particularly young people. It is the case that Ireland is a country with high homeownership. Some 60% or 70% of people own their own homes. That is a good thing. However, that is not the reality for people in their late 20s and early 30s, when it used to be. Probably only 30-something per cent of people in that age group own their own home and it would have been much higher 20 years ago. That is a breach of the social contract, in my view. If somebody works hard, plays by the rules and saves some money, they should be able to buy their home. That has become harder and harder over the past 20 years, and I acknowledge that.
The reasons for this are myriad. We have a booming population and smaller households. We had a collapse in the construction industry 12 years ago that we have still not recovered from. We are essentially running up an escalator that is moving in the other direction. We are making some progress. Approximately 25,000 new homes were built in the past 12 months, the highest figure in ten or 11 years and certainly since the current data were collected. We have had about 15,000 first-time buyers in the past year. That is really encouraging because it is the highest in 15 years. It is not enough, however. I would like to see the number of new homes being built closer to 40,000 or 50,000 and the number of first-time buyers close to double what it is now. That has to be our objective.
In the context of what we are doing about it, the response is to increase supply. We are doing absolutely everything we can to increase supply. Only yesterday, I had some discussions about that with people involved in the business. In the budget we extended the help-to-buy scheme, which helps people to buy their first homes. The Deputy will know from the independent report that it is the authors' view that the scheme has not had an upward pressure effect on house prices. That is not my view, it is the view of the independent analysis. All the more reason, I believe, to extend that, and it has been extended for two years. We are providing people with grants to do up old and derelict properties and turn them into homes. I really hope that turns out to be a big success. That also applies to sites in small rural towns and villages. We have the first home scheme. This is an affordable home scheme in respect of which we are getting really good feedback and strong interest. That scheme is helping to bridge the gap. If somebody can get a mortgage for €250,000 but the house they want or need to buy is €320,000, we can bridge the gap through shared equity. We are seeing a lot of interest in that programme. If it turns out to be oversubscribed, as it may well be, we should expand it if we can.
I asked three specific questions. They were not addressed at all in the Tánaiste's answer. I ask that he address them in his final response. There is no shortage of independent analysis which shows that Government policies in respect of housing are continuing to push up and fuel house price and rent inflation through myriad schemes that provide subsidies for developers. Every week I meet young people who, years after finishing school or college, are still living with their parents. These individuals want to be able to move out, become independent and get on with their lives. More and more people with skills that we desperately need in the country are emigrating in search of somewhere affordable to live. It is grossly unfair that the Government would seek to put the burden of paying for construction defects on people who are struggling to buy homes. The Government promised to go after those who are actually responsible for these costs. Why is this not being done? Why are the quarries that continue to produce defective materials still being allowed to operate? Defective materials are going into homes now. This will result in millions of euro of damage in years to come. Will the Government abandon its plans to introduce this very unfair levy?
I thank the Deputy. I have heard suggestions or allegations that there are still quarries producing defective materials. If that is the case, it needs to be dealt with, but the relevant authorities will need evidence of that. I am not sure if that is being provided to the relevant authorities. As the Deputy knows, any criminal prosecutions are not a matter for Government. We are a democracy. We abide by the rule of law. That would be a matter for the Garda, not for the Government.
The truth is, and I know the Deputy knows this, that it is going to cost hundreds of millions if not billions of euro to repair the homes affected by mica. We need to do that for the 7,000 or 8,000 families affected. We are also going to need to do something to help people who live in apartments that are defective. There is no quarry or two quarries that are going to come up with that kind of money. We need to find a way to recoup some of the cost. It is not fair that the taxpayer should cover all of the cost. We believe that the cost should fall, at least in part, on the industry. I have heard people suggest other methods of doing that and we are open to suggestions if the Deputy has other methods. I have head the suggestion of putting an additional levy on the profits of the construction industry. That would be passed on, too. They would increase their prices and increase their profits to compensate themselves for the levy. No matter what we do, when we decide to socialise the cost of something, the cost has to be borne in the round by society.
A moratorium on electricity and gas disconnections is in place for this winter. For most customers, the moratorium will be place from the beginning of December to the end of February. For vulnerable customers, the moratorium will apply from October to March. While this moratorium is very welcome, does it apply to all electricity and gas customers? Approximately 10% of electricity users now use the pay-as-you-go system. That would approximate to approximately 200,000 homes. For low-income households, the percentage will be higher; I suspect much higher. One constituent I spoke to last night estimated that every second house in her estate uses the pay-as-you-go system. For the purposes of this contribution, I am going to call this constituent Noreen. It is not her real name.
Noreen lives on the north side of Cork city with her husband and three kids. She is spending €100 a week on electricity, gas and heating her home. She spends €20 a week on blocks and briquettes for the stove. She uses pay-as-you-go for her electricity, which costs €50 per week to top up. She uses pay-as-you-go for her gas, which costs €30 a week to top up. Noreen goes to Centra once a week to buy those top-ups. When she is down to the last €2 on her credit, a beep goes off in the house. When she is down to zero, the beep goes off again. She is then allowed €10 emergency credit. If this runs out before she tops up, she is disconnected. What will happen this winter if Noreen’s emergency credit runs out and she cannot afford to top up? Will the emergency credit be extended and, if so, will it be extended without limits? Will she and others in the same situation be cut off? I would appreciate a reply to that. There are many people asking this question who would like to hear the official position on it.
As the Deputy mentioned in his contribution, the moratorium on disconnection applies to the end of February for the vast majority of customers and to the end of March for the most vulnerable. Ideally, it should apply to everyone. Thinking through the Deputy’s question, it is difficult to know how one would apply that in the case of pay-as-you-go customers just because of the nature of how pay-as-you-go works. The Government can help, however, and it wants to help the kind of people the Deputy mentioned.
How can we help? As the Deputy knows, there will be a fuel allowance cash payment that people in receipt of the fuel allowance will receive in the next couple of weeks. In addition, we are extending eligibility for the fuel allowance to many more people. That will kick in from the new year, subsequent to the social welfare Bill being passed by this House. A double social welfare payment will be paid in the next few weeks. For people not in receipt of social welfare, there will be a double child benefit payment and a double working family payment. That will help people with their essential bills a lot. An energy credit of €200 will be paid before Christmas and a further two credits, each for €200, will be paid after Christmas. These credits will run through to March. Then there are the emergency needs payments that are available from the community welfare service.
That is the kind of help the Government is offering in the round. I hope that answers the Deputy’s question in terms of what we can do to help people who are pay-as-you-go customers. I have outlined many different actions. The Deputy asked whether we can do it without limits. I do not think so. I do think we can say to anyone that we can cover the cost of their electricity or gas without limits. No matter who it is, I do not think that would be reasonable or right.
I am gobsmacked by the Tánaiste’s reply. He said that ideally, it should apply to everybody. However, that implies, and he clearly indicated, that it does not apply to everybody. Who are the people it does not apply to? They are the people who have been disconnected in the past and put onto the meters and are, in many cases, the lower-income people in society. Many of them are vulnerable individuals. The Tánaiste stated that there is the fuel allowance, the community welfare officer and energy credits. That will be fine; it will get many of those people through the winter. However, it will not get all of them through the winter; in fact, there is a significant number of them who it will not get through the winter. The Tánaiste is saying that they face the prospect of their electricity supply being disconnected - not just for themselves and their partners, but for their kids. That is a scandal.
The Tánaiste asked what can be done. During Covid, the emergency credit on gas was extended well beyond the usual amount. That is something that could be done. There could be a commitment given that there will be no disconnections this winter and that this will apply, not for some but for all. That is what I am asking for.
The Deputy makes a fair point. It is something that I can undertake to examine in conjunction with the Minister for the Environment, Climate and Communications, Deputy Eamon Ryan, and the Minister for Social Protection, Deputy Humphreys. We need to find a mechanism to protect pay-as-you-go customers. It is gas bills in particular that will present a difficulty over the next few months. We may see electricity prices falling or at least stabilising. The changes in the European rules around how electricity is calculated will help, as will the energy credit. However, gas bills could be particularly high over the next couple of months.
As we both mentioned, the Government is helping in many ways. It is doing so through the fuel allowance, other social welfare payments, the energy credit and the exceptional needs payments. As the Deputy acknowledged, that will be enough for the vast majority of pay-as-you-go customers throughout the winter. However, if there are particular hardship cases, we need to find a mechanism to help the people involved. I will undertake to speak to the Ministers for the Environment, Climate and Communicationsand Social Protection about precisely that matter.
For the seventh time in the past year and a half, I am raising the issue of the serious, chronic and worsening situation at Sligo University Hospital, SUH, regarding the numbers on trolleys and waiting for beds. There is no shortage of statistics thanks to Trolley Watch. While numbers fluctuate day on day, if we look at the trends, we will see what is happening. If we look at this year, from January to August, we see that compared with all other hospitals, SUH started off in January as the fifth worst. As the year progressed, it went from fourth to third. When we get to August, because that is the last full month, we see that it was in the fourth-worst position. The figures in September show a distinct disimprovement. The headline figures for the month of August, which show Sligo with 720 people waiting, do not tell the full story. One needs to look at the capacity of any hospital, such as the number of beds and staff, because that, to a large extent, determines how it can manage those waiting on beds. If we look at August of this year and compare bed capacity in Sligo and Limerick, for example, which is meant to be perhaps one of the worst hospitals from the perspective of those on trolleys and waiting for beds, we see that Sligo is the worst of all the hospitals in the country. That is measure of the real challenge that is facing SUH, not the headline figures that are screaming at us at this stage.
I am sure the Tánaiste is well familiar with this issue, not just from my interventions, but from his party's councillors and Government Deputies, some of whom described the situation recently as truly shocking. They are right; the situation is truly shocking and completely unacceptable. The situation, while it is worsening, has not crept up on us by stealth; rather, it has worsened year on year. If the Tánaiste looks at the figures back from 2006, he will see that those figures are getting worse year on year. All hospitals have experienced increases, but Sligo is the worst.
That is why I am asking the Tánaiste for an immediate, short-term response for the coming winter-spring period. I know there are longer-term plans for a 42-bed unit, and we are waiting on that. However, we need immediate action. The hospital is under severe pressure. Staff are under huge stress and suffering burnout. Covid tested all of us, but it tested healthcare staff more than others. As we face into uncertain winter and spring in the context of Covid and flu, what short-term messages can the Government put in place?
I thank Deputy Harkin for raising this important question and raising SUH again in the Dáil. She has raised this matter many times in the House and has spoken to me offline about it as well.
According to the HSE this morning, there are seven patients on trolleys in the emergency department in Sligo, but it has been much higher on other and, indeed, in recent days. I acknowledge the Deputy’s point that ten people on trolleys in a small department, such as Naas or Portiuncula, for example, is worse than ten in a very large department, such as, for example, St. James’s or St. Vincent’s.
The Deputy makes a valid point and I acknowledge it.
With regard to short-term actions, the HSE is currently preparing its comprehensive winter plan. That will include bespoke local plans for Sligo University Hospital and the community healthcare area of which it is part. It is being finalised and will be brought to the Government very shortly. In the meantime, funding has been provided for actions to take place this year. These include GP and out-of-hours support, the extension of the local injury unit operating hours, transition-care funding and short-stay respite services. Across the country, the HSE has been instructed to recruit an additional 51 emergency medicine consultants, including on a locum basis, if necessary.
Attendances in Sligo have been very high relative to the predicted range for September. The HSE is acting to alleviate congestion by prioritising diagnostics to get people discharged more quickly and also by using day services. Elective services have been pared back to six beds over recent months, unfortunately, but that was necessary.
In the past two years, additional capacity, including 41 public intermediate care beds, has been provided to Sligo. There has been an extension of the emergency department, which has provided a new reception area, a Covid assessment area, separate adult and child waiting rooms, a new nurse triage area and an ambulance arrival area, which opened back in January.
I thank the Tánaiste. On 28 September, the INMO branded Sligo University Hospital a safety hazard. That is not politics and it is not me saying it. The INMO does not do this lightly. That is where we are at the moment. The INMO has called for an urgent inspection by HIQA because of the increased overcrowding and safety issues for patients and staff. I hear what the Tánaiste says about diagnostics. That will work in two or three years; it will feed into the system. I also hear what the Tánaiste says about the 51 emergency consultants. How many of them will be coming to Sligo? I understand that there are four ICU beds in Sligo not opened because the HSE is not sanctioning the required staff. Did budget 2023 ensure the deployment of the 30 additional staff needed for Sligo University Hospital? This is what we want to hear. I do not expect the Tánaiste to wave a magic wand today such that the waiting list will disappear tomorrow but I want to see some kind of immediate action so the people attending the hospital and its staff will know some support will be in place for this winter and next spring.
I thank the Deputy. As I mentioned in my earlier reply, a winter plan is being developed. There will be a bespoke winter plan for Sligo, taking into account not only the hospital but also the community services in the wider area. Diagnostics can help quite soon. I know from bitter experience, both as a doctor and Minister for Health, that patients very often must wait a long time in hospitals, particularly over weekends, to get the scans or tests they need. Then they must wait for a senior decision-maker to decide whether they need to stay or can go home. Just having more diagnostics, particularly in the evenings and at weekends, and having senior decision-makers on site, can speed up services. Just reducing the average length of stay by half a day can be as good as providing dozens or hundreds of additional beds across the health service. You need to do all of these things to reduce the average length of stay, and also provide additional bed and staff capacity.
As the Deputy mentioned, there are plans for a new four-storey block for the hospital. That will include 42 new beds, as well as additional staffing for critical care. That is needed as soon as possible. The Minister of State, Deputy Feighan, is working very hard on this and I know Deputy Harkin is too. We need to get it under way as soon as possible but also to make the short-term changes.