Thursday, 13 July 2023
Ceisteanna ó Cheannairí - Leaders' Questions
The new national children's hospital will be a game changer for the children of Ireland. It will be a fantastic, world-class hospital. It will nearly double surgical capacity and provide the best modern care, which the children of Ireland need and deserve. I want to see this hospital built and opened as soon as possible. I think that is in everyone's interest and it is what the children of Ireland deserve, but the long-running saga of the new children's hospital, a fiasco, it has to be said, from the start, has now descended into farce. There is no certainty about a final cost or a final completion date. There has been no honesty about the scale of the challenges we are facing with this project. We learned this week that the board has reached the end of the road on its original budget. It is looking for hundreds of millions of euro more from the Government to continue this project without any indication of what the final cost will be or when this hospital might open. All the while, 100,000 children are languishing on hospital waiting lists.
The Government has made promises time and again, which the Tánaiste has reiterated, to children with scoliosis that they will get the care they need within four months, but many, as he knows, are still waiting for years. These children need this hospital built and opened as soon as possible.
When the Taoiseach, Deputy Varadkar, was Minister for Health, he said he committed to opening the hospital by 2020 "unless an asteroid hits Earth". In 2019, when releasing a damning PwC report that found major underestimations of cost and extremely poor governance, the Taoiseach said it was his priority to meet the 2023 opening date. It then became March 2024 and in the past few weeks, it changed again to May 2024. Yesterday, astoundingly, the board could give no indication or certainty on when the hospital would be handed over. I have no confidence that this hospital will be open and ready to treat patients in 2024. I think it is a certainty now that it will be 2025, and God knows when in that year.
The board and the contractor are now openly at war and all the while, the costs are rising. This is in nobody's interest. It does nothing to help the children who need this hospital built. It is unseemly and unprofessional and it does not inspire confidence that the Government can deliver this project on time and in cost. We need action from the Tánaiste's Government. We need urgency and we need leadership. What we need now is not more fictitious timeframes or costs. Every timeframe we have been given has come and gone, and all we can see - all taxpayers can see - is more cheques being written, more money being spent, more delays and more cost overruns. We need a real date, we need a real timeframe and we need to do everything possible to ensure this project is brought back on track.
There is a responsibility on the Minister for Health, who is sitting next to the Tánaiste, to get off the sidelines and show leadership, knock heads together and ensure the board and BAM are doing everything possible to make sure this project comes in on time. I am sure the Tánaiste would accept we cannot simply continue to write cheques with no guarantees. Is the Government going to commit more money to this project without any certainty on a completion date? Exactly how much additional funding has been sought by the board, beyond the €1.7 billion already committed?
First, I agree with the Deputy that the new children's hospital will be transformative when completed and will represent a significant step change in tertiary care for children in this country. The opening of the two satellite centres has already had an impact. I visited the site last year when I was Taoiseach and there is a greater degree of completion now than there was some years ago. Since the Government came into office, it has had a very clear focus on the hospital. That focus is about getting the hospital complete but also getting value for money and ensuring there is a rigorous process in terms of cost. I respect the Deputy's right, of course, to raise these issues on a continuing basis - that is his job as Opposition spokesperson - but in the public debate and the history of this entire project, in terms of the politicisation of the hospital or issues around cost and so on, we have to be careful we are not playing into somebody else's hands. I have been adamant from the outset, when I became Taoiseach two and a half years ago, that we had to follow a rigorous process here.
Yes, there is no question there have been tensions. There has been a real difficulty here and perhaps one would not start out again if one were starting to build a new hospital. The last thing we should ever do in regard to public contracts is start putting costs out there. We should tender and see what comes in. Claims are being made now but the claims are being challenged every step of the way, and that is right. There should not be compromise on contesting those claims. I mean that, and if that means delay, so be it. Just 2% is the outturn of all the claims made so far, because they are being contested through mediation. We could cut corners and say let us not contest these claims and give more, to hurry up and accelerate the completion, but that game is over. That is not going to happen and it has not happened over the past two and a half years. The contractors have responsibilities, as does the National Paediatric Hospital Development Board. It is charged with delivering this project. Painful and unsatisfactory as it is in terms of completion timeframes, we need to stick with the process and not create leverage for anybody to see weaknesses on the State side whereby the State is somehow going to compromise its position in a mad political rush to get this completed because it might not look well if we do not get it completed before a certain timeframe.
I do not approve of that approach at all. We have to be hard and fair. We want the hospital to be completed, but if claims are being made that are not sustainable, they have to be tested. That means arbitration and mediation, and that is slow. Covid-19 and various issues have delayed the project. By definition, every building project in the past two years has gone up in costs, as we know through housing and everything else. Those costs are going to feed their way into the children's hospital, as will costs caused by delay. From our perspective, we want the hospital built. It will be transformative when it is built for children's quality of care and the physical environment of children's care. We just have to stick with it. The development board is working with the contractors to get this done, all the time making sure, from the point of view of the public interest, that value for money is a key priority, that there is cost containment and that we do not just surrender to every claim made.
Excuse me, I am putting questions to the Tánaiste. His Ministers, including the one sitting next to him, were talking about March of next year as a completion date and then the Department of Health was saying it could be May. I did not put those dates out there. The board did and they were reiterated by the Minister. Previous dates were stated by previous Ministers as well.
On costs, the Tánaiste's Government approved the total programme cost of €1.7 billion, and we now know the board is looking for hundreds of millions of euro more. The Tánaiste is saying the days of throwing more money at this project are gone. Will he wake up and see what is happening? Is he seriously telling me the Government is not going to give any more money to this project? That is not what we are being told by the board.
My understanding is this will go to Cabinet. Before any more taxpayers' money is handed over, will the Government guarantee there will be a completion date that is real and realistic, not fictitious?
Let us get this hospital built. This is not about anybody playing politics. This is about making sure this hospital is built for the children who need it.
With respect, I never said anything about anybody not getting additional funding. The Deputy just said that I did. That is untrue. Do not be putting words into my mouth. The Deputy came out two weeks ago about sources he had saying that remedial works needed to be carried out. In the public interest the Deputy should reveal the sources.
I am answering the Deputy's question. I am simply saying that in the public interest. There are lots of agendas here. I am not talking about the Deputy now. I am talking about the cost of this. We must protect, as best we can, the taxpayer. I never gave a date on this. The reason I did not give a date is that I am aware of the tensions between the contractor and the hospital development board, which have been there for a number of years. There is no secret about that. There is way to deal with this and it is not in the public glare of big grandstanding statements-----
It is in the nitty-gritty and the daily grind of contesting the claims that are being made and testing them objectively, and then doing the best on behalf of the taxpayer.
This is the final opportunity I will have to ask the Tánaiste questions before the Dáil rises for the recess. I want to ask the Tánaiste about housing. The Dáil may be going into recess for two months but there will be no break in the number of evictions, no break in the number of notices to quit that are sent, and no break in the number of men, women and children who are made homeless every day. There will be no break in the stress for those people currently wondering how they can continue to keep the roof over their head and pay record rents in the middle of a cost-of-living crisis. There will be no break for the hundreds of thousands of young people who are wondering when they will be able to afford to move out of their parents' homes. There will be no break from the fear, anxiety and trauma that comes from being affected in this housing crisis.
People are living with constant dread and fear because of the Government's failure on housing. There are record rents, record house prices, record levels of homelessness and record levels of young adults living in their childhood bedrooms. It does not have to be like this. There are things the Government could be doing differently. The very first thing it could do is reinstate the no-fault eviction ban and at least try to ensure that no-one else becomes homeless this year. Second, the Government could be doing so much more to tackle the enormous levels of vacancy. In every single town, village and city across the country there are boarded up and vacant homes. To feign an attempt to address this the Government introduced a vacancy tax this year, but set it to just 0.1% of the value of a home. It is pathetic. The Government could immediately increase that too.
Then there is the issue of delivering affordable homes. The Government only managed 323 affordable homes out of a target of 4,000 last year. As the Tánaiste is aware, affordable homes are key to addressing this crisis. We know it can be done. The Ó Cualann housing alliance has an excellent track record. It has not been given the support it needs to really ramp up supply.
I have three questions for the Tánaiste. In the Housing For All progress report this week, there was no mention of how many affordable homes have been delivered this year. Why not? What is the figure? The Government failed to spend €1 billion of the housing budget last year. Has it managed to spend this year's budget? Homelessness has relentlessly increased for 16 of the past 17 months. Will the Tánaiste reinstate the no-fault eviction ban?
With respect the Deputy she has been very short with proposals or options for the housing supply side. She has not put anything forward. There will be no break in house building. There are record levels of house building going on right now. If the Deputy had read the progress report this was very clear. Last year 30,000 houses were built. This is a 45% increase on 2021. We need balance in the debate and I respectfully ask that there would be some acknowledgement at least of the progress in house building and supply. Some 25,000 first-time buyers drew down mortgages in 2022. This is the highest number since 2008. There were 6,716 new dwelling completions in the first quarter. We are having record levels of completions and record levels of commencements. This is 19% up on the first quarter of 2022. In the year to April 2023 some 50,000 homes were purchased by households. Of those, 17,000 were purchased by first-time buyers. In 2023 there has been a strong uptake in commencements, with 28,000 homes commenced in the year to May 2023, and 13,000 of those were in January to May. This is the highest level of commencements for this period since records began in 2014. The Government will continue to implement different measures. In social housing, for example, which the Deputy did not reference at all, we have seen the highest level of delivery since 1975 with more than 10,000 social homes delivered between new builds, acquisitions and leasing. If we take the housing assistance payment for rental accommodation this is 20,000 additional households that had their social housing needs met in 2022. There is also a strong pipeline of about 19,000 social homes either onsite or at design and tender stages. Again, in 2023 funding is in place to deliver nearly 12,000 social homes, including 9,100 new-build homes. Therefore, 26,000 social homes have been added to the social housing stock under this Government up to Q4 of last year. This is very significant progress.
There are also the first-time buyers' supports, which perhaps the Deputy does not agree with, such as the help-to-buy scheme and the first home schemes. These are having a real impact on the affordability for young people to be in a position to buy homes. There were 38,000 first-time buyers that have now been assisted with the help-to-buy scheme. The evidence is strong. On cost rental homes, there have been significant developments. It is, in essence, a new model, with 700 cost rental homes delivered in 2022. The new cost-rental subsidy will now improve the viability of apartment development in urban areas and will deliver more cost rental homes.
With regard to the eviction ban, it is our view that this would have made the situation worse in the rental market. The intervention of the various initiatives the Minister has taken, and the in situtenant purchase scheme in particular, have been very impactful in the context of the numbers who are facing eviction. The local authorities are now in the process of buying the houses for the tenants so they can stay in their homes.
It is not a surprise that the Tánaiste rejects my criticisms on housing. We are all used to witnessing this kind of denial from the Government now. To say that I have not given any solutions is something we hear on a regular basis. Obviously in this Leaders' Questions slot I cannot give every single solution to the housing crisis. In my contribution I mentioned three things that could be done on vacancies, on the eviction ban and on affordable homes. It is clear the Tánaiste will never listen to the Opposition on these issues, or will only highlight something that has not been mentioned in the short speaking slot that I have.
What does the Tánaiste have to say to IBEC? It can hardly be described as Government critics or as housing activists or as some sort of left-wing fire brands and yet housing is now one of its main concerns. IBEC has said the State is losing out on new investment and new business because of housing constraints. In other words, there is nowhere for workers to live. IBEC, as a business lobby group, is highlighting the concerns of businesses. Unfortunately, there is no lobby group for children growing up in homelessness, or for young adults living in their childhood bedrooms, or for families who have lost hope of ever owning a modest home. Is this why they are so far down on Government priority lists?
The Tánaiste claims to have turned a corner on housing. Everything in his speech would swear that everything is rosy. Does this mean that for the first time the Government will actually deliver its targets on affordable homes? Does it mean the Government will spend its budget? What on earth does it actually mean for people who are looking at a notice to quit, who are facing homelessness and who are stuck in their childhood bedrooms?
The most effective advocates for housing should be in this House. No-one should be depending on any lobby group. I do not depend on IBEC to tell me that housing is the biggest crisis in this country. I have said this from day one since I came into Government. On coming into Government I was adamant that a member of our party would become the Minster responsible for housing, to take on the challenge and to build greater progress.
-----it is not enough and we need more housing. The problem, I respectfully suggest, is that the propositions the Deputy brings would actually reduce the supply.
That is the challenge. All of the Deputy's approach-----
-----over the last two and half years has been against measures that would increase supply and has been about the introduction of measures that would reduce supply. That is a fundamental problem in terms of the Deputy's policy proposition.
We are committed to social housing and affordable housing, and on the vacancy, the Deputy knows the Croí Cónaithe grants have been increased from €50,000 to €70,000-----
There is also the new revolving funding of €150 million. Therefore, for the first time in a long time, there is a focused, targeted and well-resourced programme on vacancy and dereliction. The Deputy should at least acknowledge that, but there we are.
I wish to revert to the issue of overcrowding in hospitals across the country, in particular, the hospital closest to me, which is University Hospital Limerick, UHL, in Limerick. I wish to put it in context as well because, on 14 January 2014, then Deputy Micheál Martin raised the spectre of overcrowding in hospitals. He stated that the Minister had neglected it as a priority in government and that is why there were record numbers last week, and the Minister tried to get away with it but got caught. The then Minister for Health, now Taoiseach, Deputy Varadkar, responded that Deputy Micheál Martin wasted money when there were billions of euro sloshing around. He also stated that the overcrowding in hospitals went back to the Tánaiste's time as Minister for Health and that he would solve it as Minister for Health. At this stage, I suppose we are much less concerned with when it started and whose fault it is than when it will end and who will solve the problem.
The Tánaiste has repeatedly said that the Government is a victim of its own success because of the rise in life expectancy. There has been a rise in life expectancy but not a hugely dramatic one. In 2014, life expectancy was 80.56 years in Ireland. It is now 82.81 years. It is an increase, but not one that would explain overcrowding levels. In January 2014, in the middle of winter, when Deputy Micheál Martin raised this issue, there were 359 people on hospital trolleys, 34 of whom were in Limerick. Today, in the middle of summer - everybody knows it will get much worse when we enter into the winter period again - there are 390 people on trolleys across the country, 97 of whom are in UHL.
We spend a lot of money on health in Ireland. We did then and we do now. We spent €19 billion on health in 2014 in the midst of an economic crisis. The country was on its knees and the Government still found €19 billion to spend on health. We spend more than that now. We spend almost €24 billion on health. By OECD levels, we spend almost as any other country on health but it seems, from my perspective, and maybe the Tánaiste will differ with me, that our outcomes are not as good as those of other countries. Trolleys are, of course, in every hospital but the large numbers on trolleys seem to be a particular Irish problem. There is money sloshing around us, as Sinn Féin already pointed out with regard specifically to the national children's hospital. Is money being wasted? I do not know the answer to that. We have seen much wastage of money in other Government areas. Does that carry across to the HSE, because, like RTÉ, there is a new chief executive officer, CEO, in the HSE who seems intent on reforming practices and getting value for money?
I thank the Deputy for raising the issue. In terms of lifespan generally, the last 20 or 30 years have seen a dramatic improvements in lifespan. Over the history of the State, we have gained 25 years in lifespan. In terms of health outcomes, there have been fairly dramatic improved outcomes on cancer care and survival rates and cardiovascular in terms of survival from cardiac issues. Heart disease was a huge killer in Ireland. It still remains a killer, but less so than it would have heretofore been. Stroke has been dramatically improved. The outcomes from stroke now are much better and it is all about early intervention. If one looks at the area of pre-ambulance emergency care, the professionalisation of that has been transformative over 20 years. Sometimes when we talk about health spending - it is exponentially growing - we also have to acknowledge that in a lot of areas there have been a lot of good outcomes because of that investment.
The focus on the emergency departments and the overcrowding is valid in regard to whether we are getting the outcomes that we should be getting by now in terms of the investment, both in human resources and in physical capacity. We have to add the population growth, which is a significant factor which was probably under provided for in some respects over a period, because we have gone from 3.5 million people in the 1990s to 5.2 million today and in the last two years alone the population has significantly increased for a variety of reasons. That is set to continue in Ireland because historically the population was probably lower than it should have been if one looks back to the Famine period and right through. The population growth is a key factor.
On University Hospital Limerick, the trolleys are down 20% compared to 2019 but that is not enough. The outpatient list is down 30%. There are an additional 730 staff, 100 additional beds and 200 more under construction. There is a surgical hub on the way. However, we need reform as well. The seven-day week roster idea is important in terms of getting better use of the asset that a hospital represents, and out of the equipment and the facilities, etc., and getting better value for money, get more productivity and get greater volumes done.
With all the investment, the volume of activity is increasing all of the time as well. That gets lost in all of the figures. To be fair to the health service, sometimes we do not give recognition of the fact that the extra spending has meant extra activity, operations and diagnostics. We have to continue to invest in community and primary care to take the pressure off the acute service and make sure people get the right care, at the time and in the right and most appropriate location.
I welcome the emphasis on primary care. There is a great new primary care centre in Ennis. The Minister for Health, Deputy Stephen Donnelly, opened it. I welcome that, but there is a shortage of GPs right across Clare and right across the country. It is increasingly difficult, as I highlighted to the Taoiseach, to get an appointment to see a GP in Scarriff. That will be exacerbated by the new arrivals of persons seeking international protection and persons with temporary protection because no additional resources are being provided. There are difficulties in Newmarket-on-Fergus. We had a meeting about it last night.
That all means that I was getting phone calls from constituents during Christmas last year saying they could not get a GP anywhere, they had been told not to go to hospital, they had nowhere to go and they had a sick child, and asking what should they do. There was nothing I could say to them. I suppose what I am looking for is an assurance that this will be solved and that in eight years' time we will not be blaming the Government or the Minister for Health of the day for not solving the problem. Is it resources? Is it organisation? Is it a waste of resources because we can predict rises in population, rises in birth rates and rises in life expectancy?
It is all of the above. It will need more resources, if one looks at the trajectory of health expenditure. Much of that is on the human resource because the human capital in health has increased. The numbers of people working in the health service have continued to increase but more and more services have come on stream with it.
It means more investment of capital, in equipment and in additional capacity in hospitals. It should and has to mean more investment in primary care. In that respect, there is a significant increase in training places for GP and for allied health professionals and an increase in medical places in the training colleges. That will be essential, as will the recruitment of internationally qualified primary care practitioners or GPs.
There is greater accessibility now to GPs, from the income threshold perspective. There has been a very dramatic increase in access, from a financial point of view, where more people now have access to a GP card.
However, the point is well made in terms of the need to increase the number of GPs. Training places have been significantly increased, and attracting people from overseas to work in Ireland will also be a necessary part of filling the current gaps in primary care need.
I raise the appalling way my constituents and applicants in this State are being treated when it comes to making an application for a permit through the disabled drivers and disabled passengers scheme. As the Tánaiste is aware, the scheme provides relief from vehicle registration tax and VAT on an adapted car, as well as an exemption from motor tax and an annual fuel grant, open to severely and permanently disabled persons as a driver or passenger. It is also open to certain charitable organisations. However, to qualify for the relief the applicant must hold a primary medical certificate issued by the board of the Disabled Drivers Medical Board of Appeal. However, this is not happening and has not been happening for years, following the resignation of all members of the previous Disabled Drivers Medical Board of Appeal in November 2021.
I know from my engagement with the National Rehabilitation Hospital that 1,000 applications are still waiting to be processed by one person. One person is expected to process 1,000 applications. This is up from the 726 severely disabled people who were awaiting an appeal at the end of last year. Indeed, 382 of those appeals date back to 2021. I know the Tánaiste will agree that this is absolutely no way to treat disabled people or any citizen of this State. It is leading to massive levels of isolation and frustration for disabled drivers and their families. It has to be dealt with urgently. Last December, the Minister, Deputy Donohoe, when he was Minister for Finance, stated he was hopeful a new board would be up and running in January 2023. Here we are, seven months on, and the new board is still not in place. I would like assurances and a timeframe from the Tánaiste as to when this issue will be attended to and given the serious priority it deserves. The longer the board of appeal is out of action, the more the backlog will build, with all of the delays that come with that. Will the Tánaiste ask the Minister for Finance and the Minister for Health, who is seated beside him, to work together to resolve this mess and this chaos, to give disabled drivers their freedom and independence back? Those are basic rights.
I thank the Deputy for raising this issue. She is correct to say this has gone on for far too long. It is not satisfactory. I will engage with the Minister for Finance to bring forward proposals to deal with the issue. It has had a long history. There was an earlier scheme in the 1990s that was broader. At that time, the then Department of Finance had views that it was too broad and it narrowed it. Most of us who have experience dealing with the current scheme, as it was in terms of the criteria and so on, accept that it is particularly narrow in terms of who can gain eligibility under the scheme. There are two elements. A review is needed of the criteria governing eligibility and the re-establishment of the board in the context of the conclusion of that review. There also need to be mechanisms to make sure people can process their applications and get outcomes in a timely manner. I will engage the Minister for Finance on this. The Deputy has raised a fair point. I acknowledge that and I will revert back to the Deputy.
I thank the Tánaiste. I completely concur with his comment that the criteria are too narrow. That could be part of the problem why the recruitment of five people for the board is proving to be, and has proved to be, so difficult over the past two years. That could be the kernel of the issue. We also need to look at the massive workload it entails. If five people are recruited to roles on the board, I believe it takes a quorum of three for the appeal hearing. That needs to be looked at and some sort of efficient mechanism put in place to assist people who agree to join the board.
I want to make the point that my constituents who have contacted me about this are frustrated. It is not good enough. We want to move forward with rights for disabled people. We have ratified the UN Convention on the Rights of People with Disabilities. That was not before time, and we were one of the last countries to do so. We need to move forward and make sure our words match our actions. I welcome that the Tánaiste has said he will engage. It needs an urgent intervention and it has to be made a priority.
The Minister for Health is engaging with the National Rehabilitation Hospital in the context of the operation of this scheme to make sure there are sufficient numbers of necessary medical resources and staff, and on the broader issue of the volume of applications in terms of there being sufficient numbers on the board or to support the board in respect of processing the applications. I understand the urgency and importance of this for many people who benefited from the scheme in the past and those who fall to benefit from it now and in the immediate future.
I take the opportunity, which I should have at the outset, to thank the Ceann Comhairle and all of the ushers and staff in Leinster House for their courtesy, co-operation, tolerance and infinite patience with all of us. We wish them a bit of a break, or rather, more of a break. They will obviously still be here but will have some respite from the day-to-day pressures of the House being in operation. I sincerely thank them on my behalf, that of the Government, and all of the Government parties.
I thank the Tánaiste. I need to begin by thanking him, the Taoiseach and the members of the Government, Deputy Mary Lou McDonald and the leaders of the other parties and groups for their unfailing help, support and courtesy over the course of the year. I extend our good wishes to those of our Members who are unwell at present. I hope we see them all back fit and well in September. I join the Tánaiste in expressing our gratitude to the Secretary General and all of those in the services across the whole spectrum of activities in the House. We are fortunate to have people who work with us and support us in our every action, who are unfailingly courteous and supportive, and who have dedicated their lives to public service through the service they give to this House.
I also thank the journalists who keep a careful eye on us. They are behind me so I cannot see them, but they are behind all of us all of the time-----
-----keeping an eye on us. We need never to lose sight of the fact they fulfil an essential role on behalf of the public in keeping an eye on us and informing the public, very often in a positive way, of what is happening. I am also conscious that we are at a point in the electoral cycle where tensions are beginning to build.
Therefore, I say to Members, please, look after yourselves during the summer break. The cynics will think we are off on our long holidays, as they will always do. You, the Members, know, and I know, that people will be working assiduously in their constituencies. Maybe take a little time away from your phones. If Deputy Danny Healy-Rae were here, I would be advocating that to him in particular. But please, you need to spend time with your families and with your loved ones. We are not going through a dress rehearsal. If you do not do it now, you will not get the opportunity to do it in the future.
Looking back, we have a very interesting couple of months. Since 1 December 2022, we have had three presidents address jointing sittings: President von der Leyen, President Metsola and the extraordinary visit of President Biden.
All of those went off without any difficulty thanks to the excellent preparatory work our staff did. Go raibh maith agaibh go léir agus bíodh samhradh an-mhaith agaibh ar fad.