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Chuaigh an Cathaoirleach i gceannas ar 14:30
Machnamh agus Paidir.
Reflection and Prayer.
Business of Seanad
An Cathaoirleach:   I have received notice from Senator Trevor Ó Clochartaigh that, on the motion for the Commencement of the House today, he proposes to raise the following matter: An gá atá ann go dtabharfaidh an tAire Sláinte léargas ar cén straitéis atá á cur ar bun ag an Rialtas chun dul i ngleic leis na liostaí feithimh in Ospidéal na hOllscoile, Gaillimh.
I have also received notice from Senator Joan Freeman of the following matter: The need for the Minister of State with responsibility for mental health services and older people to outline the plans she has for mental health services for younger people, in particular, the need to stop the practice of children being detained in adult mental health units, the proposed budgetary contribution for youth mental health services in the upcoming budget and the need to extend the child and adolescent mental health services procedure to 16 to 18 year olds.
I have also received notice from Senator Máire Devine of the following matter: The need for the Minister for Health to outline how his Department intends to deal with the serious concerns being raised by the Psychiatric Nurses Association which have led to planned industrial action.
I have also received notice from Senator Jerry Buttimer of the following matter: The need for the Minister for Transport, Tourism and Sport to make a statement on the ongoing talks between the Department of Transport, Tourism and Sport, Norwegian Air International and the US authorities on transatlantic flights from Cork Airport.
I have also received notice from Senator Martin Conway of the following matter: The need for the Minister for Agriculture, Food and the Marine to review urgently the guidelines in place for valuing cattle deemed to be reactors following TB testing, given that they are clearly inadequate and proving to be a financial burden on farm families.
I have also received notice from Senator Rose Conway-Walsh of the following matter: The need for the Minister of State with responsibility for the Office of Public Works to provide an update on the commitments made to communities affected by flooding, in particular in Crossmolina, County Mayo, and the need to instruct the OPW to arrange for the dredging of the River Deel while the river bed is dry and to confirm that it is within his scope to seek and secure a derogation under the EU habitats directive to deal with the health and safety issues presented by the lack of flood protection mechanisms and structures.
I have also received notice from Senator Neale Richmond of the following matter: The need for the Minister for Justice and Equality to review urgently the system for processing applications to the National Vetting Bureau, given that the current system is clearly overwhelmed, leading to inordinate delays in processing.
I have also received notice from Senator Victor Boyhan of the following matter: The need for the Minister for Health to update the House on the expected timeframe for the roll-out of the new National Rehabilitation Hospital in Dún Laoghaire, County Dublin.
I have also received notice from Senator Colm Burke of the following matter: The need for the Minister for Health to establish a forum involving all interest groups in the provision of care for the elderly, including the HSE, the Department of Health, Nursing Homes Ireland, general practitioners and geriatricians, in order to plan and develop the way in which services should be provided for elderly people.
I have also received notice from Senator Kieran O’Donnell of the following matter: The need for the Minister for Social Protection to outline his plans and the timeframe for the introduction of a jobseeker's benefit scheme for the self-employed.
I regard the matters raised by the Senators as suitable for discussion. I have selected the matters raised by Senators Trevor Ó Clochartaigh, Joan Freeman, Máire Devine and Jerry Buttimer and they will be taken now. Senators Martin Conway, Rose Conway-Walsh, Neale Richmond, Victor Boyhan, Colm Burke and Kieran O’Donnell may give notice on another day of the matters they wish to raise.
Commencement Matters
An Cathaoirleach: I understood the Minister of State, Deputy Helen McEntee, was to take the first three matters; however, she has no briefing material on the first matter. Therefore, we will deal with the second matter first. I must be strict on time, given that last week somebody complained that I had given five minutes to one speaker and less time to another.
Mental Health Services Provision
Senator Joan Freeman: I am honoured to be a Member of the Seanad and grateful to have the opportunity to serve my country and be a representative of the most vulnerable people in the country. It is no secret that I do not have a political bone in my body, which perhaps might be good. However, I take the role of Senator very seriously and for however long the Government is in office, I will work tirelessly to help the mental health groups which are trying to bring about change in the mental health system and will support them every step of the way.
I am setting up meetings with various interest groups which have been relentless in their quest to bring about change. I have pledged to be their voice on the inside and that I will highlight to all political parties the need to implement the recommendations made. However, because of my experience in recent weeks in the House, I am sure all political parties are united in their consensus and support and belief that the needs of the most vulnerable people in society must be addressed.
Besides highlighting and helping mental health groups in pushing their agenda and expressing their concerns, I also have an agenda. My heartfelt desire is to address the problems concerning children. The Taoiseach once said Ireland was a great country in which to grow old. I hope, following his term in office, he will be able to say that for children Ireland is a great country in which to grow up. However, to do this, we must begin with the most defenceless - children with emotional and mental health problems. They rely on existing mental health services and turn to the State for treatment, support and a brighter future, but I am sorry that we are very much letting them down.
Before I focus on the issues and difficulties facing us, I emphasise that my concerns do not relate to the hard-working men and women in clinical services such as the child and adolescent mental health services, CAMHS, because they, equally, are frustrated at the ever-increasing waiting lists and poor staff levels. I am outraged by the grinding slowness of promised changes that children have to endure, changes which expert groups have recommended but to which no one has listened. It is not only these groups that have demanded changes. In 1997 the European Court of Human Rights, ECHR, found that Ireland was in breach of its commitments in the temporary placement of mentally ill minors in adult institutions owing to the lack of age-appropriate care places. Despite these findings, the Mental Health Act 2001 has still not been reformed to provide for the children concerned.
Let us consider the seriousness of the lack of urgency or a commitment to change the existing admission procedures. The Government may argue that, at the end of 2013, there was a 5% decrease in the number of admissions of children to adult units, but the Mental Health Commission reported yesterday that there had been an increase at the end of 2015. Five more children were admitted to adult psychiatric units, giving a total of 95. There will be reasons to justify their placement in these units - the lack of beds, the difficulty in accessing beds outside office hours and the difficulty in conducting assessments outside office hours and at weekends. However, these are the same excuses that have been expressed for the past seven years since the Mental Health Commission issued an amendment to the code of practice on the admission of children. Meanwhile, 15 years later, the Mental Health Act still ignores the fact that children are being placed in adult units and, 19 years later, the Government continues to ignore the ECHR.
While the Minister of State's advisers may suggest children are placed in these units for their own safety, many of them are placed in the psychiatric wards of general hospitals in which there are patients experiencing significant mental health difficulties, ranging from addiction to schizophrenia to dementia and eating disorders. Everyone will recall the terrible tragedy on a psychiatric ward in a general hospital in Dublin when one patient stabbed another. However, the Government is stating children are being transferred to a safe place.
Many Senators have young children and teenagers and I call on them to imagine one of their children having an eating disorder, being depressed or having suicidal thoughts. If they were told that they needed to wait almost two years before being seen, what would they say?
Many of us were fortunate to enjoy a healthy childhood without having to experience the inadequacies of the mental health system, yet most of the children in the mental health system are waiting for us to help them and we can. We can help them to grow up and become well balanced individuals, despite their earlier difficulties. With the right support and care children can put these difficult years behind them. All of us, at some stage in our lives, have had a second chance. I am asking that these children be given just one to lead a life like every other child.
I appreciate that the Minister of State has come to listen on these issues and hope she realises I do not see my role as criticising her, the Department or the Government; rather, I see my role as helping her to achieve what the Government has promised for years, namely, a loving nurturing society in an environment that is full of dignity and respect and that will allow children to look forward.
An Cathaoirleach: The Senator needs to be careful. She was allowed four minutes and usually Members take two, but she took seven. When I ring the bell, it indicates that her time is up. The trouble is that if I grant her latitude, someone will come along the next day and say I gave her seven minutes.
Senator Joan Freeman: I am so sorry.
An Cathaoirleach: It is the Senator's first time and I did not want to stop her. She is very passionate about the subject.
Senator David Norris: The Cathaoirleach was very gracious and the Minister of State is extremely welcome. On a point of order, is it not a little unusual that there are no civil servants present?
An Cathaoirleach: Not during the Commencement debate.
Senator David Norris: I cannot remember a time when a Minister defended a point on her own.
An Cathaoirleach: I chaired the Commencement debate many times in the previous Seanad. It would be more unusual if advisers were present for it.
Senator David Norris: That is new. I was just curious.
Minister of State at the Department of Health (Deputy Helen McEntee): The officials will be here with me tomorrow for the debate on mental health services. I hope the Cathaoirleach will not take time from me.
I apologise to Senator Joan Freeman; I was not aware that I was to take the first matter also. I hope we will be able to resolve the issue. I thank the Senator for her contribution. She has represented the people on the matter of mental health services for some time and I know that she will continue to do an excellent job in representing them in her new position in which I wish her the very best. Mental health services continue to be a priority for the Government and, as the Senator correctly pointed out, all people within the Seanad and Leinster House. This is reinforced by the fact that funding for mental health services this year will increase by €41 million, or just over 5%, to approximately €826 million, as indicated in the HSE's national service plan.
The reduction in the number of children admitted to adult psychiatric units has been a priority in recent years and I assure the Senator that it continues to be a priority. Progress has been significant. The Senator mentioned that the number had increased by five last year. However, in 2008 it was 247 which declined to approximately 95 last year. We are making progress, albeit there was a slight increase last year. This is despite the increasing demands placed on child and adolescent mental health services overall. Such admissions are made for a number of reasons, including distance from particular centres, with families not wanting their children to be sent 40 km, 50 km or 60 km away; the timing of admissions late at night; possible medical issues; substance misuse issues; family concerns and overall safety.
It is the policy of the HSE to provide an age-appropriate service, with a significant majority of young people now being treated by child and adolescent mental health services, CAMHS, teams. While figures for 2015 show that there were 95 admissions of children to adult psychiatric units, the number of admissions does not necessarily equate to the actual number of children admitted, as a child may be admitted on more than one occasion in any given year. In 2015 there were 356 CAMHS admissions, of which 73% were to age-appropriate units and 27% to adult units. The HSE works proactively to reduce both the number and length of stay in such admissions.
We are certainly not ignoring the issue. While there was a reduction to 95 in the number of admissions of children to adult units, it is not acceptable for any child to be in that position. Admissions of this nature should only take place when absolutely necessary. We need to reach a position where zero children will be admitted to adult units.
There has been a significant increase in CAMHS bed numbers in the past 12 months - that is where we can see an improvement - with 66 operational beds at present. This improvement has been assisted by the weekly management of available beds nationally. An example of progress is that an additional consultant resource has recently provided for the Eist Linn unit in Cork which will bring capacity closer to 20 in the coming months. I hope the number will increase and surpass 66, which will help to improve the position. The HSE continues to roll out protocols for the placement of 16 to 18 year olds in line with age appropriate placements as local operational issues allow.
On youth mental health services, there will be a continuation of investment in primary care responses to mental health issues, including counselling services, Jigsaw projects, of which three are being rolled out this year in Cork, Limerick and Dublin, as well as early intervention approaches. The question of further enhancing youth mental health services in the forthcoming budget will be considered in the context of the forthcoming Estimates process for 2017. I am establishing a youth mental health task force to consider how best to assist young people in developing resilience and coping skills to support their emotional well being at an early stage. I hope the task force will be launched in mid-July before the recess.
I assure the Senator that I have taken on board her concerns. I understand where she is coming from and look forward to working with her to, I hope, improve the service.
An Cathaoirleach: A debate is due to take place tomorrow on mental health services when the Senator will be able to contribute again. If she wishes, she may ask a brief question. The problem is that 12 Members requested permission to raise matters in the Adjournment debate this morning and I had to refuse eight of them. If the system was structured correctly, we would be able to take five matters instead of four.
Senator Joan Freeman: I thank the Cathaoirleach and the Minister of State for-----
An Cathaoirleach: In other words, the contribution made on this issue was probably more appropriate on Second Stage of a Bill rather than asking the Minister a question.
Senator Joan Freeman: I am more than happy to meet the Minister of State to come up with a short-term response to the problems that are being encountered. We could address some of them very quickly, but we need to meet other interested parties also. I hope the Minister of State can agree to do this.
Hospital Staff
Senator Máire Devine: Can I have seven minutes, too?
An Cathaoirleach: No.
Senator Máire Devine: I thank the Minister of State for her attendance. On behalf of nurses, midwives, medics and other health care staff, I welcome her to her post and hope to work collaboratively with her and the Minister for Health, Deputy Simon Harris. I refer to the first phase of industrial action next week by the Psychiatric Nurses Association and ask the Minister of State to intervene.
The dispute concerns the 30% shortage of psychiatric nursing staff, which means that there are no community services available and that there is a chaotic health care system in place in inpatient units. The recommendations made in A Vision for Change on community input have not been implemented, but that is a matter for consideration in tomorrow's debate. In fact, more than 75% of the recommendations made have not been implemented. As the approved inpatient centres need to be staffed, there is no one available in the community to provide modern health care services to take us from the Victorian age to providing fit-for-purpose services for the young, the old and newborns. There is not one mother and baby bed in the entire country. Post-natal depression or post-natal psychosis which has a huge impact on the bonding of mother and child is prevalent among women.
I am aware that the Minister, Deputy Simon Harris, is meeting the Psychiatric Nurses Association tomorrow with a view to having A Vision for Change implemented. I hope the Minister of State will be able to intervene and set out a meaningful programme to build up staff to stop the chaos in hospitals and prevent overcrowding. When somebody sent on therapeutic leave is doing well, he or she is telephoned on the Sunday and asked not to come back which enables somebody else to take the bed.
However, they are all registered as using that one bed. We need the sharing of bunk beds at this stage. I would appreciate the input of the Minister of State in that regard. We need to bring our nurses home from abroad and respect them and give patients the quality of care they deserve.
An Cathaoirleach: I thank the Senator who has balanced the books somewhat because she took less than three minutes.
Deputy Helen McEntee: I thank the Senator for her question and contribution and wish her the best in her role. I will touch specifically on the planned industrial action this week. It is timely, therefore, that the Senator has asked the question. While it was directed to my colleague, the Minister for Health, Deputy Simon Harris, it falls within our collective remit. The Minister sends his apologies for being unable to be here.
As the Senator pointed out, the Minister met representatives of the Psychiatric Nurses Association earlier this month prior to the completion of the ballot on industrial action. Unfortunately, I was unable to attend, but I hope to meet them tomorrow or later this week. At the meeting representatives of the association outlined the concerns of their members about current and pending staff shortages and the need to focus on recruitment, retention and service development issues. The Senator has outlined many of these issues. Since the result of the ballot was announced there has been engagement between the HSE and the Psychiatric Nurses Association with a view to averting the industrial action which is due to commence on 29 June. Following contacts between the parties, an initial meeting took place last Friday and another is scheduled for tomorrow. Obviously, representatives of the Department of Health will attend that meeting. At last week's meeting the representatives of the association again emphasised the significant recruitment and retention challenges mental health services faced, given the age profile of psychiatric nursing staff. They also expressed concerns about the capacity of the system to implement A Vision for Change.
I emphasise that the Government is committed to providing additional resources for mental health services. As I mentioned in my previous address, this is shown clearly in the increase in funding for mental health services from €785 million to €826 million this year, an increase of 5.2%. The Government is also committed to reinstating the full 2016 provision of €35 million in new development moneys to enable service priorities in the mental health service to be progressed in line with A Vision for Change. The additional funding will enable further recruitment to priority posts throughout the mental health sector and the ongoing development of community mental health teams.
We face a genuine implementation difficulty in some areas, a point which has been acknowledged. It does not relate primarily to a lack of funding and is far more a question of sourcing staff and reconfiguring services and structures. Only this morning I spoke to officials about a particular post, in respect of which there had been three recruitment drives, one of which was international. Despite this, it has been difficult to fill the post. There are, therefore, major challenges in this area. Having said that, some 1,550 new posts have been approved, of which 1,150 have been filled since 2012, but there are still have many gaps that we need to fill. The HSE is experiencing significant challenges in recruiting suitably qualified nurses in this area, with a significant gap between the number of nurses who are graduating and the positions that need to be filled. In that context, the HSE has made provision for the rehiring of retired mental health nursing staff. Some nurses have been rehired. I realise there are a number of issues about the pay scale, something the Department and the HSE are addressing with nurses. The HSE is focusing on facilitating the retention of these nurses and engaging to ensure this will happen. It is also focused on streamlining recruitment processes, increasing the number of student places available, recruiting graduating nurses and ensuring permanent contracts can be offered to all eligible psychiatric nursing staff. It is in the best interests of patients and nursing personnel that the parties engage constructively on the key issues involved in order that industrial action can be avoided at all costs.
The Senator and I share the same objective, that is, improving the delivery of services to ensure the health service delivers the services it is supposed to deliver. I am satisfied that the Psychiatric Nurses Association and the HSE are committed to continuing positive engagement and I will certainly do whatever I can to play my part in that process.
Senator Máire Devine: I do not want to be negative, but I have been involved in this game for a long time. In the 1990s the level of funding for mental health services was 14%. It is now somewhere in the region of less than 6%. I become cynical when I hear that it will be increased by 5.2% and when I hear talk year after year of the figures of €41 million and €35 million. We never actually get our hands on that money, but it is announced as a new input every year.
There is cynicism in that regard, but I hope the Minister of State will be able to write down in black and white where the money is coming from and will be allocated and confirm that it will be handed over as opposed to being retained. There was outrage when the sum of €12 million was diverted from the mental health budget and lost in other services that are seen as being less in the background. Mental health services have always been seen as the Cinderella of the health service.
The Health Service Executive recruitment drive in recent years has been miserable. At most, one or two psychiatric nurses have been attracted from abroad. Most psychiatric nurses are too angry to come back as they were forced to leave - that is a quote from the HSE - as were other medical staff and doctors. They were forced out by the yellow pack, degrading contracts. There is not one such contract available in the country now, of which we are very proud. The then Government realised its faux pasin that regard.
Hiring retired staff is a possibility, but I can tell the Minister of State that most psychiatric nurses cannot wait to get out the door owing to burnout. It is a physically, mentally and emotionally demanding job. We try to do our best, but when one is working in chaotic, understaffed conditions and watching the effects on patients and their families, it causes burnout. We, too, are human, but it is to be hoped there will be some thinking outside the box that will allow us to improve the health service, especially in mental health services, to ensure it serves the needs of the people.
An Cathaoirleach: There seems to be a problem with the matter Senator Trevor Ó Clochartaigh wishes to raise. Does the Minister of State have some information on the matter?
Deputy Helen McEntee: I apologise and ask the Senator to resubmit the matter he wishes to raise.
An Cathaoirleach: Gabh mo leithscéal. There seems to be a problem, I believe at departmental level, even though Senator Trevor Ó Clochartaigh submitted the matter he wished to raise last week. I accepted it in good faith and rejected five others. There will be a debate today and tomorrow on health issues and we might be able to find another way to raise the matter, but if the Senator resubmits it either this week or next week, I will try to give him priority.
Senator Trevor Ó Clochartaigh: I thank the Cathaoirleach and the Minister of State. I appreciate a mistake has been made and will resubmit the matter. I will talk to the Cathaoirleach or the Seanad Office about when it would be most appropriate to do so.
An Cathaoirleach: I thank the Senator and the Minister of State. Does she want to respond briefly to Senator Máire Devine?
Deputy Helen McEntee: Only last week I signed off on a figure of €18 million of the €35 million development fund. We are clear on where it is going, namely, to fill new posts but also to develop older services to ensure the environment in which staff are working is modern and appropriate to the work they do. There is much more to do. More emphasis needs to be put on recruitment. We must ensure the number of places available in colleges matches the number of places we need to fill. I look forward to working with the Senator and will engage with her on every matter, where possible.
An Cathaoirleach: Senator Máire Devine will be on the Minister of State's case regularly if no progress is made.
Air Services Provision
An Cathaoirleach: The Minister, Deputy Shane Ross, is taking the final matter. He is welcome.
Senator Jerry Buttimer: I thank the Cathaoirleach for allowing me to raise this matter of importance. I welcome the Minister, Deputy Shane Ross.
I raise the important issue of Cork Airport and the link with the United States of America. As the Cathaoirleach is well aware, last year Cork City Council, Cork County Council and the tourism bodies lent support to the publication earlier this year of the Growing Tourism in Cork strategy, central to which is the importance of Cork Airport and the need to see it connected with routes to North America. Last year was a good one for Cork Airport which saw the opening of 12 new routes and improved passenger numbers. With the EU-US Open Skies agreement, this is the opportune time to have a transatlantic link between Cork Airport and North America. Norwegian stepped in and offered to provide a service between Cork and Boston. Prior to the dissolution of the Dáil and the general election, ongoing efforts were made at Government and EU level to have this link established. However, there is an impasse on the American side.
The European Commission's Director General for Mobility and Transport was in Washington recently to negotiate and plead with the US authorities on the need to have this transatlantic link established.
I commend the Minister for his earlier comments on this very important issue. It is economically important for job creation, tourism and to increase footfall in Cork and the wider Munster region, but it also concerns the EU-US Open Skies agreement which is meant to stimulate the sector and increase passenger numbers and make more options available to passengers. Norwegian is willing to provide this link and the United States cannot be allowed, for whatever reason, to pick and choose or engage in selectivity in how it allows airlines or carriers to become involved.
I appreciate the fact that I am raising it as Leader of the House, but this is a very important economic matter which concerns the granting of a licence. It is about ensuring people in the areas in which the Cathaoirleach and I live have that choice and that we can continue to grow numbers in Cork Airport. To be fair to staff at the airport, they have been putting together a submission based on the creation of jobs and the provision of new routes. In the week when the Vice President of the United States, Mr. Joe Biden, will visit Ireland, would it not have been opportune for him to come on the new transatlantic route out of Cork Airport? I hope we can raise the matter with him during the course of his visit.
Minister for Transport, Tourism and Sport (Deputy Shane Ross): I thank the Senator for raising this subject. It is a good day on which to raise it and I hope the message will be sent to the Vice President, Mr. Biden, that we are not happy with the behaviour of various groups in the United States in the blockage of an airline from landing in the United States. The Senator will also be aware that the Taoiseach has raised the matter with the President of the United States, Mr. Barack Obama. It has been raised at various levels around the world, certainly at EU level. When I met the European Commissioner early last week, I mentioned it to her. She said she was sick and tired of making telephone calls about it and that I could make that information public and that they were tired of listening to her. However, they are making every effort to deal with it. The delay is totally unacceptable. It would be opportune if the American Government were to move on the issue promptly and it would certainly be opportune if the Vice President were to make a statement on it in the coming days. In that context, I thank the Senator for giving me the opportunity to address the matter which has been raised with me on a number of occasions and which I know is of importance to the people of Cork and surrounding counties. It is not just a Cork issue; it is an issue which affects us nationally and the international flying world.
Cork Airport is recognised by the national aviation policy as a unique gateway to the Wild Atlantic Way and Ireland's Ancient East, the two main tourism promotion initiatives under way. Passenger numbers have fallen at the airport each year since 2009 and been slower to recover than those at Dublin and Shannon airports. A total of 2.07 million passengers travelled through Cork Airport in 2015, a decrease of 3.4% on the figure for 2014. Significantly, however, passenger numbers began to recover in the final quarter of last year and this positive trend has continued in 2016, with growth of 8% up to the end of May. The airport will launch nine new routes and services in 2016 and believes the rate of passenger growth could be up by 8% for the year as a whole. I am hopeful one of the new routes will be the service to Boston by Norwegian.
Norwegian Air International was licensed as an Irish airline in February 2014. In August 2015 the airline announced plans to operate transatlantic services from Cork Airport, which was very welcome. However, in February this year the airline had to postpone the launch of these services because the US Department of Transportation had not yet granted it a foreign carrier air permit. This is very regrettable as the proposed Cork to Boston route would be the first such transatlantic service from Cork Airport and a very welcome boost to Cork and the wider region. It is my understanding this is the first instance since the EU-US Open Skies agreement was introduced in 2008 that an airline has been prevented from launching a new transatlantic service due to a delay in approval being granted by the US authorities.
We say this as a friend of the United States and are puzzled by the fact that it cannot reciprocate. The delay is clearly not in the interests of the many people on both sides of the Atlantic who intend to avail of the new service.
When the EU-US Open Skies agreement was introduced, it was an example for the rest of the world of the benefits of the open skies policy which had the interests of customers at heart. It was designed to encourage the new competition Norwegian Air International offers. A tentative decision was made by the US Department of Transportation on 15 April to grant a permit to Norwegian Air International. This tentative decision was the subject of a public consultation process which concluded in May, but there is no clear timetable for a final decision to be made. However, I look forward to the decision being confirmed as soon as possible in order that the airline can start operating on the new route from Cork to Boston and other new transatlantic routes.
This and the previous Government have supported Norwegian Air International and the introduction of the Cork to Boston route. My predecessor, the Taoiseach and the Minister for Foreign Affairs and Trade have all made the case for Norwegian Air International to the US authorities on many occasions. I delivered the opening address at the recent IATA AGM, my first aviation-related public engagement, and reiterated this support for Norwegian Air International. In my address I emphasised my deep regret at the delay in granting the permit to Norwegian Air International and the need for a continued move towards increased competition and further liberalisation in the aviation sector. The European Commission has also been supportive of Norwegian Air International from the outset. Most recently, as referred to by the Senator, the Director General for Transport made strong public statements in support of the airline. The Commission has confirmed that it reserves the right to take action under the agreement, including initiating a formal arbitration process. I hope that by confirming the tentative decision made to grant Norwegian Air International its permit there will be no need for this next step to be taken. In the meantime, the Department and I will continue to liaise closely with the Irish Embassy in Washington, the Irish Aviation Authority and the European Commission. We will continue to take the appropriate steps to help to secure this important new service for Cork Airport.
Senator Jerry Buttimer: I thank the Minister for his support and the endeavours he has undertaken not only on behalf of the Department but also the people of Ireland. I speak as a friend of the United States, not as a foe, in promoting the EU-US Open Skies agreement and highlighting the need for the permit to be issued immediately. The Minister is correct. We need to see arbitration. This is about the EU-US Open Skies policy. I hope that during the visit of the US Vice President, Mr. Biden, that members of the Government will impress on him the importance and centrality of the new route from Cork Airport in promoting the country in North America.
Deputy Shane Ross: I endorse and echo what the Senator said. I will not meet the Vice President, but I hope any member of the Government who does meet him will make clear our dissatisfaction at the attitude in the United States and highlight the fact that we, as a friend of the United States, expect an early decision to clear the blockage.
Sitting suspended at 3.15 p.m. and resumed at 3.30 p.m.
Order of Business
Senator Jerry Buttimer: The Order of Business is No. 1, statements on health services, to be taken at 5.15 p.m. and conclude not later than 6.45 p.m., with the contributions of all Senators not to exceed six minutes each and the Minister to be given five minutes in which to reply. As Members will note from the Order Paper and the schedule, I propose that immediately following the Order of Business we have expressions of sympathy for the late Jo Cox, MP, who was tragically shot and killed last weekend. As we have limited time, I propose that we confine contributions to five minutes per group spokesperson and that members of groups may share time, if they so desire.
Senator Catherine Ardagh: I refer to the gun attack on a young man on Monasterboice Road in Crumlin during the early hours of yesterday morning. This latest gun attack in the heart of my constituency, just a short distance from my office, is of concern to me and the Fianna Fáil group. Less than half way into the year, seven people have lost their lives in the bloody war between two feuding families in this city. While the circumstances surrounding yesterday's shooting remain unclear, it is clear that the measures introduced by the Government are failing miserably in curtailing gun attacks across Dublin.
I call on the Tánaiste and Minister for Justice and Equality to come to the House to set out and explain the actions she intends to take to provide the Garda with the resources and manpower it needs to effectively put the people running around the capital city with guns out of business. It is unacceptable that any community is living in fear and waiting for the next gun shots to ring out. I firmly believe the Minister and the Government have failed to comprehend the seriousness of the gun attacks in the capital city, the first of which took place in January, and that they have since failed to resource and support the Garda effectively in tackling crime head on. It is for that reason that I call on the Minister to attend the House. While I acknowledge arrests were made at the weekend owing to the increase in the level of surveillance, I also note that the armed response unit, for which €5 million was announced in February, has yet to be set up. I ask the Minister to examine the introduction of stricter sentencing legislation for the possession of firearms and perhaps the introduction of mandatory minimum sentences for such offences.
Senator David Norris: The issue I wish to raise is bin charges. The major mistake made was providing for privatisation. It was an absolute disaster. We all know what happened in Italy. The Mafia controls the collection of rubbish. What did we see happen here? A while ago we had bin companies attack the lorries of others and burn them out in car parks. That is pretty close to the activities of the Mafia. The companies involved are not even registered in Ireland; they are registered in the Isle of Man and because of this we do not know whether they make a profit. We pay for the collection of bins through the bin tax; we pay for water through water rates; we pay for roads through road tax, but for what is the revenue from property tax used? I think it is used to pay off the gambling debts of the German and French banks. We now have a situation where, as we heard this morning, 86,000 people have had money taken from their pension payments and other sources of income without their consent to pay the property tax. Some 3,000 people were sent to the sheriff to have their goods distrained. That is appalling. This takes us back to the 19th century to rack-renting where if a peasant dared to improve his or her holding, the landlord shoved up the rent, which meant that he or she was punished. What is now being done is exactly the same.
Some 40 years ago I bought a house on North Great George's Street for £25,000. I have spent hundreds of thousands, possibly millions, of euro on it. I started the North Great George's Street Preservation Society and rescued No. 35. I was involved in the transfer of ownership of many houses and although we rescued the street, what has been the result? We have been punished. The property tax has been increased, which is unspeakable. People should not be taxed on their homes. One's home should be inviolate. I said the same about mortgages, that there should be a Minister with responsibility for home security to make sure Irish citizens would be able to stay in their own homes.
I look forward to the debate tomorrow because there is an awful lot more to this issue; there are some very shady takeover deals between the companies involved. I do not believe they have been monitored properly by the authorities. The situation is appalling. It is part of a mass privatisation programme by the Government and I hope it will be stopped in its tracks and that the process of privatisation can be reversed. If half a dozen companies can make a profit, I do not know why Dublin Corporation could not at least run it on an equal basis. Until recently in my area there were five or six refuse companies operating and every bloody day of the week we had bin lorries travelling up and down street at all times of the day and night. As I said, I look forward to tomorrow's debate, but I use the opportunity to call on the Order of Business for something to be done about this matter.
Senator Rose Conway-Walsh: I raise the issue of Brexit and its effects here because it will be too late to raise it next week. I appeal to Irish people living in Britain and our comrades in the North of Ireland to vote in favour of staying as part of the European project.
I make this appeal because of the consequences of Brexit which have been outlined, not least the reinstatement of the Border and the impact this would have on the Thirty-two Counties. There is learning in this issue for all of us because it shows how much the all-Ireland economy is dependent on relationships between Ireland and Britain, across all issues, including agriculture, fisheries, rural development, health and the economy. The House could play a part in setting out a vision for how to integrate an all-Ireland strategy with all of the work we do. While I welcome the increased co-operation between Ireland and Britain, it must continue and we must further examine developments in the British economy. The most recent ESRI report indicates that Ireland will not reach the rate of growth forecast for next year. The interdependence of the two states needs to be at the forefront of everything the Seanad does. Above all, I encourage people to use their franchise later this week for the betterment of the Thirty-two Counties and the United Kingdom.
Senator Lynn Ruane: As we approach the end of the 2015-16 academic year, the Cassells report which was due for publication eight months ago has still not been published. The higher education sector is at crisis point. Students are being charged a steadily increasing fee to attend college under the guise of a contribution charge. These increases and the corresponding decrease in State funding for higher education have had a noticeably negative impact on the quality of education. We are seeing poorer graduate outcomes and a diminished global reputation, two crucial factors in attracting a diverse range of students from across the country and around the world. The outputs of third level institutions provide €10 billion for the economy and international students make a further economic contribution of €1.3 billion. While increasing investment in higher education has a major social impact, it also has a strong, noticeable and positive economic impact. The wealth and progress of a country rely heavily on the level of educational attainment of its population. The benefits of a publicly funded and accessible higher education system clearly outweigh the benefits of education enjoyed by the individual. However, this is not reflected in State investment.
When one moves to commodity education, universities are transformed into training centres influenced by industry which then requires a faster return on investment. This commodification was exactly what was proposed to the Minister for Public Expenditure and Reform in a recent document prepared by departmental officials. The move towards a €4,000 annual fee, supported by a student loans system, would put higher education further out of reach of those who need it most. The document in question also refers to the expected drawn out nature of the introduction of a student loans system. If we intend to expend energy and valuable political capital in resolving the higher education funding crisis, we should look towards a strategy that would benefit higher level institutions and students equally and would not bury young people in debt. In a period of economic recovery it is time the State reinstated third level education funding to pre-crisis levels, possibly in the next three budgets. Indebting young people limits opportunity and choice and pushes graduates into employment to meet loan repayments rather than pursuing the career they want to follow or changing employments as they wish. We must continue to treat education as a public good.
It is now more crucial than ever that we see publication of the Cassells report, the findings of which will provide the future framework of third level education. The report has been delayed for eight months and the new academic year will start in a short time. While some of the report's contents have been leaked, third level students deserve to know its full contents, but they are being left in the dark about the future of the third level sector and their financial commitments for the coming year. In recent years it has become almost a given that the State can no longer afford to publicly fund third level education, but this is not true as it is becoming increasingly clear that the State cannot afford not to fund third level education. This issue needs to be debated in the House before the next academic term commences.
Senator Kevin Humphreys: I take the opportunity to ask the Leader to obtain some information for the House on the Adoption (Information and Tracing) Bill. A lot of work has been carried out on the Bill and I would hate to see it slip off the radar at this stage. Former Deputy Anne Ferris did a huge amount of work on the legislation which is very important.
I also request information on the Criminal Law (Sexual Offences) Bill. There was all-party agreement on the report compiled by the justice committee. The Bill passed through all Stages in this House following a set of strong contributions made by many Senators and had commenced Second Stage in the Dáil. Will the Leader ascertain what the current status of the Bill is and when it will be reintroduced? It will be a very important Bill in protecting sex workers and dealing with the issue of criminalisation. I would be grateful if the legislation was brought forward.
On the comments made by Senator David Norris on bin workers and waste charges for the lifting of bins, I, too, look forward to the debate tomorrow. Those who forced the issue and in the process moved the service away from local authorities by engaging in a daily protest and the encouragement of people not to pay waste management charges to their local authorities are the very ones who generated the privatisation of the service. As soon as the private sector companies moved in, I did not see one protest against them. When local authority workers provided a very good public service throughout the country, the very same people were at the forefront of the protests and demonstrations and in the locking of bin lorries into yards, thus not allowing them to collect refuse in this city and many other parts of the country. Therefore, I very much look forward to tomorrow's debate. It will be an opportunity for us to hear the views of Members of different parties, but let us remember the forced privatisation through a non-payment campaign against the local authorities.
Senator Frank Feighan: Last weekend I noted with great interest the celebrations to mark what would have been the 125th birthday of John A. Costello. As Senators will know, he was leader of Fine Gael, a Taoiseach and also in 1949 declared Ireland a republic. Up until that time, it was an active member of the Commonwealth. Relations are now at an all-time high with the Commonwealth that has a population of 2.2 billion and comprises 53 countries, of which 33 are republics. Since 1971 the Queen has had only a titular role in the Commonwealth. As there is support for world peace, liberty, human rights, equality and free trade, it would be a good time to have a debate on whether the Republic of Ireland should consider rejoining the Commonwealth. Many members of the Irish diaspora live in the United Kingdom, Australia, Canada and New Zealand; we should not, therefore, fear rejoining.
Senator Mark Daly: I did not see that mentioned in the Fine Gael manifesto.
Senator Frank Feighan: This is a mature republic. We must seek a debate to discuss the economy and the fact that there are 2.2 billion people in the Commonwealth. It is time we took our place again within it. The Republic of Ireland should consider the matter.
Senator Mark Daly: We will see how Brexit goes first.
Senator Terry Leyden: I ask the Leader of the House to invite the Minister for Jobs, Enterprise and Innovation to attend the House to discuss the soaring cost of car insurance. There is a need for a review of the workings of the Injuries Board that was established in 2004. It is a State organisation that contributed initially to a reduction in premiums and the cost of claims. At this stage compensation awards are soaring. I refer, for instance, to compensation levels for soft tissue injuries. In a case involving whiplash the average compensation payment is €15,000, compared to a figure of £5,000 or thereabouts in the United Kingdom. There is a big difference in claim costs.
There is also a significant number of fraudulent claims.
Government action is needed in this regard. Fraud is widespread, with accidents being arranged and organised. The damages awarded are soaring and the insurance companies have increased premiums by up to 50%. This is making it very difficult for young people, in particular, to obtain or retain motor insurance.
We have all come across cases of abuse of the insurance system. I know of one case in which an individual got a scrape on his car and received €4,500. Six months later he discovered that he had soft tissue injuries. The doctor said it was fine and no problem because the claim had been submitted. The insurance company did not carry out a detailed examination or investigation of the individual concerned, even though he had submitted numerous other claims. It settled for a sum of €10,000 or €15,000 because it did not want to incur the cost of obtaining medical advice, senior and junior counsel or solicitors. Companies will just settle claims, but who pays? The person who pays the premium is the one who carries the can at the end of the day. It is about time action was taken. I, therefore, ask the Leader to invite the Minister to come to the House to discuss the issue. We have Members with a wide range of experience. Many of the professions are represented in the House, including medical doctors, senior counsel, junior counsel, solicitors, lawyers and so forth, and they could give their views on the matter. We want fair settlements and insurance premiums, particularly for young people. We are paying for the Quinn Insurance collapse, uninsured drivers and so on. These issues are all connected, but who is paying? Young people who want to drive a car are being victimised. I ask the Leader to consider arranging a debate on the issue.
Senator Catherine Noone: I join Senator Terry Leyden in calling for a debate on the cost of motor insurance.
I heard a victim of cyber harassment on radio, an interview which colleagues may also have heard. I was shocked to hear how the young woman concerned had endured an outrageous violation of her privacy when explicit pictures and a video were posted online by a disgruntled ex-boyfriend. She was completely unaware that she was being filmed and that the film was online until somebody pointed it out to her. The investigation and prosecution of this activity are very poorly provided for under Irish law. This leaves the Garda with limited scope to act in such circumstances. Thankfully, Irish legislation is very strong for child victims, especially in the case of the distribution of child sexual images. However, protections are far weaker for adults who have been seriously victimised on social media or online, including being depicted in intimate private photographs and videos. Last year the United Kingdom passed legislation which made it illegal to disclose a private sexual photograph or film without the consent of the person depicted. In the United States 34 states have revenge porn laws in place, while Australia and New Zealand have also recently introduced state laws criminalising it. Recent amendments to the 1951 Post Office (Amendment) Act which criminalises the use of a phone for harassment purposes include text messages sent by phone. However, it is unclear if suspect activity on social media conducted online via a smartphone is covered by the legislation. Because of the lack of prosecutions, there is no case law. It is totally unacceptable that there is no legal deterrent in this country for anyone who wishes to violate another person's privacy in the most explicit way. I am calling for the introduction of legislation in line with that recently introduced in the United Kingdom to provide adequate protection for adults from the scourge of cyber harassment and revenge porn. This affects women, men and teenagers and should be taken more seriously.
Senator Gerard P. Craughwell: I refer to the treatment of workers. There was a lot of discussion in the House when Clerys vanished off the face of the earth leaving hundreds of workers unemployed. My colleague, Senator Gerald Nash, introduced good legislation in this area when he was a Minister of State. Members of the IMPACT trade union who work for Childminding Ireland have been on strike since 7 June because they were served with compulsory redundancy notices without any meaningful talks taking place.
The proposed redundancies are unnecessary. Childminding Ireland is a State-funded body which is not experiencing financial difficulties and management has failed to produce a business case to justify the job losses. IMPACT believes Childminding Ireland is illegally threatening redundancies to force administrative and specialist staff out of their jobs before replacing them with others. Childminding Ireland has refused to engage seriously in consultation or conciliation organised by the Workplace Relations Commission, although it has misleadingly told journalists that it has conducted a four-month consultation process. In fact, according to the union, no consultation has taken place. Childminding Ireland has had plenty of opportunities to explain why it thinks restructuring and redundancies are necessary, but it has consistently failed to do so. It is clear that no business case has been made because there is none. Although management has stated existing staff members will be able to apply for as yet unspecified new roles in a restructured organisation, the union believes the new roles are being constructed to exclude such persons. It remains available to resolve these issues through negotiations at the Workplace Relations Commission. It is trying to protect its workers before some fly-by-night dumps them on the street as happened in the case of Clerys. I am not saying the State-funded body in this case is wrong in its belief that redundancies are needed, but there should be some way of compelling it to go before the Workplace Relations Commission to justify what it is looking for. It should be required to enter into meaningful negotiations. It is outrageous that the workers are protesting out on the street today. I ask the Leader to address this issue with the relevant Minister.
Senator Colm Burke: Senator Terry Leyden raised the important issue of increased insurance costs, but he did not refer to the profits of insurance companies. We got rid of the jury system a number of years ago in deciding on the level of damages because we thought such a move would lead to cheaper insurance. We then set up the Personal Injuries Assessment Board because we thought it would result in cuts in legal fees. The insurance companies now want further cuts because they are still not satisfied. Nobody is talking about the profits being made by insurance companies or the need for them to be upfront on the reason insurance costs so much in this country. There is a need for an honest debate on the matter. It is important to recognise that every time we pay insurance premiums, it costs us all more because of bad management within an insurance company, Quinn Insurance, where moneys were used wrongly.
I understand a committee has been established to deal with the ten-year health care plan, but there is no reference to any Member of the Seanad being on the committee. It is important to emphasise that Members of this House could make a contribution to the debate on the plan. I ask the Leader to seek clarification from the Minister for Health on the inclusion of Members of the Seanad in the committee when it discusses the ten-year plan.
Eight months ago in this House the former Minister of State at the Department of Health, Kathleen Lynch, gave me a commitment that a report on the review of the fair deal scheme, particularly as it applied to farmers, would be made available in June 2016. I ask the Minister for Health to make that report available as we need to have a debate on the matter. It is extremely important that there be a level playing field for everyone under the fair deal scheme.
Senator Paul Gavan: I also want to refer to Childminding Ireland. I attended the protest at lunchtime today and have to say I was shocked to hear about the treatment meted out to workers like Bernie Griffiths, Jacquie Donnelly, Fiona Turner and Anne McCourtney, who have given over 60 years of loyal service to a company that is funded by the State through the Department of Children and Youth Affairs.
Despite this, when IMPACT wrote to the Minister-----
An Cathaoirleach: The Senator should not name people in the House who are not here to defend themselves. He should be careful not to do so.
Senator Paul Gavan: I am here to support them.
An Cathaoirleach: Either way, they make take issue with it. I am just cautioning the Senator.
Senator Paul Gavan: Thank you, a Chathaoirligh; I accept your point. We have heard much about new politics and have a new Minister in place. However, when the union wrote to her, she appeared to sit on her hands, saying it had nothing to do with her. Her Department funds the child care facility in question. It has made the people in question redundant and, at the same time, told them to reapply for their jobs, if they like to do so. Does the House see this as acceptable behaviour in the 21st century? None of us should and I believe none of us would. The issue is urgent. The people concerned are in their third week on strike and we need a response from the Minister. Will the Leader urgently ask her to address the issue?
Senator Gabrielle McFadden: I am deeply concerned about the process through which school building projects are progressed through construction and the order in which they appear on the final list. Will the Leader invite the Minister for Education and Skills, or a representative on his behalf, to outline the procedures involved to the House? The new school building project at Coosan national school in Athlone is close to my heart, as it was for my late sister Nicky McFadden. For more than 16 years we worked to have it included in the new school construction list. It was approved, completed stage 2B and was to proceed to construction in 2016. We have been informed that 66 buildings will proceed to construction this year, but our school is not one of them. There is a school in my locality which came on-line only two years ago, after Coosan national school, and where construction will start next week. While I welcome the development, there is an unfairness in the process. I would like to see some transparency in the process to understand how and why some projects are jumped up the list. Up to 65% of the pupils in Coosan national school are in prefabs. Vital work is required on the existing school building over the summer which will not be cost effective if the project is to come on-line in 2017. Will the Minister for Education and Skills explain to the House how one school which has been in the process for 16 years can suddenly be dropped, while the project at another school which has only been involved in the process for two years can suddenly proceed to construction?
Senator Victor Boyhan: In most of the media today there have been comments that the Minister for the Environment, Community and Local Government is proposing to instruct local authorities to introduce charges at civic bring centres. This is rather odd, as it is meant to be Government policy that we allow and empower local authorities to make decisions on their affairs and operate within their budgets. This is one of the common problems with the property tax because no one quite knows what they are paying it for or understands the autonomy of local authorities to manage their affairs in a professional way. I believe in water and waste charges. The difference lies in having fair water and waste charges, with the services being provided for people explained to them. There is a massive fiasco about waste, with many people jumping for headlines and publicity, stating they are against this or that. We have to pay for services. People need to get real. It seems to be the in-thing to say one is against everything. I am in favour of water and bin charges. One gives a good service and explains the cost, while not ripping people off. Will the Leader arrange for the Minister, when he comes into the Seanad tomorrow for the debate on waste charges, to explain his intentions in suggesting or directing local authorities to charge citizens who take the trouble to manage their waste and take it to a civic bring centre? These are the ones who are proactive in segregating and managing their waste. I would be against any charge for such a service.
Senator Ray Butler: I raise the issue of commercial business rates for small and medium-sized enterprises, SMEs. Recently, I was asked to attend the local courthouse to see three businesses being dragged before the court like common criminals because they were in arrears in paying their local authority rates.
This is happening all over the country, not just in my area but in everybody's. As the economy improves and grows, more local authorities are putting the boot down. Businesses have survived during the past five or six years through a disastrous economic crash and should be put on a pedestal for keeping their doors open, but instead they are being crucified. Politicians have done nothing to address the issue. The rates Bill dates back to the 1800s and its only provision is that people must pay. We all put on the green jersey two years ago when social and GAA clubs needed help on the rates issue. We introduced legislation, which was fantastic and right. I appeal for politicians in this and the other House to do something about our draconian rates legislation. Business owners who have employed people and paid their taxes, including VAT, are being dragged before judges like paupers. We need the legislation to be changed and must debate it in the House. We need to see if companies in the past five years have broken even or lost money. If they have broken even or lost money, we should consider helping them and, in some cases, wiping the debt. In some cases, the debt has been wiped and favouritism has come into play in certain local authorities, whereas in others they have gone the whole hog and collected the money. We should help SMEs by introducing legislation which should provide for calculating rates based on profits rather than the square footage of a premises. A premises in a small rural town where five people might pass the door in one day might pay the same amount in rates as a premises in the Blanchardstown Centre where thousands of people pass through the doors. It is ludicrous. I call on the Minister to come to the House to debate the issue and help those who have kept their doors open and helped rural communities but who are being slaughtered and dragged down. What I see happening is disgraceful.
Senator Niall Ó Donnghaile: Éirím chun tacú leis an méid atá ráite ag mo chomhghleacaí, an Seanadóir Conway-Walsh. I support the contribution made by my colleague, Senator Rose Conway-Walsh, and ask the Leader to maintain the pressure on his Government colleagues and all Members of the Oireachtas on the Brexit referendum. I will leave this institution on Thursday after the conclusion of business to travel back up the road to vote in the referendum. When I was travelling to Leinster House last week, I sat across from two young American tourists who were heading from Belfast to Dublin. They asked an elderly gentleman in the carriage whether anybody would stop them at the Border to check their passports and papers. I interjected by saying, "Not yet." This is a fear and concern, among many others, not least about the impact on the economy, infrastructure, the agriculture sector and the longstanding and important contribution the European Union has made to the peace process, as well as the political process, in the North through institutions and the very significant funding streams to build peace and justice initiatives. I ask the Leader to maintain this pressure. The Government has played a very proactive role. The Taoiseach and other colleagues have been to the North, which I welcome. They have also travelled across the water to Britain to encourage the Irish community there to vote. I ask Members to maintain this pressure and that, if they have friends, colleagues or relatives in Britain or the North, to ensure they use their vote on Thursday. I say this as an individual and a party member who has many concerns about the European Union, as it stands, not least about the democratic deficit and the erosion of national sovereignty.
I am amazed at and shocked by Senator Frank Feighan who is no longer in the Chamber. I hope he is outside reflecting on what he proposed. If I am worried about the democratic deficit in the European Union, I would certainly be worried about a democratic deficit in the British Commonwealth.
I am amazed that in 2016, 100 years after the Easter Rising, when the ideals and visions have not yet been fulfilled, that a member of Fine Gael would come into the House-----
Senator Mark Daly: He wants County Roscommon to join the Commonwealth.
An Cathaoirleach: I ask that Senator Niall Ó Donnghaile be allowed to conclude without interruption.
Senator Niall Ó Donnghaile: If Senator Frank Feighan does, he would ask us to doff the cap, bend the knee and crawl back into the British Commonwealth. It was a shameful contribution and I hope we will all treat it with the contempt it deserves.
Senator Mark Daly: It might be an April Fool's joke or something.
An Cathaoirleach: This is a democratic institution in which every Member can make a comment, although Senator Niall Ó Donnghaile may not like it.
Senator Maria Byrne: I support Senator Ray Butler's call on SMEs and the rates they must pay. Will the Leader ask the Minister for Jobs, Enterprise and Innovation to come to the House to discuss the provision of incentives for small companies to set up? I acknowledge that they work with LEOs and that a number of small companies have been set up in recent times, mainly in urban areas,. There is more positivity among SMEs, but we must work with and encourage them to develop.
Senator Trevor Ó Clochartaigh: It is great to see the new politics of Fine Gael coming around to Sinn Féin policy, particularly on the issue of rates, because for the past five years Sinn Féin has been calling for a change to rates in order that they would be calculated on the basis of profits and the size of businesses. I agree with Senators Maria Byrne and Ray Butler that a debate is needed on the issue and it is good that they are finally coming around to our way of thinking.
Tá sé fíor-thábhachtach go mbeadh díospóireacht againn maidir le cúrsaí Gaeilge agus Gaeltachta. Bhí caint ar Acht na dTeangacha Oifigiúla sa Rialtas deireadh a bhí ag dul ag cúlú ó thaobh na cumhachtaí a bheadh ag an gCoimisinéir Teanga. Bhí feachtas pobail ann ag cor an choinne sin. Tá an straitéis 20 bliain titithe i dtraipisí. Níl dóthain acmhainní á cur ar fáil agus níl dóthain tacaíocht á thabhairt don teanga. Tá Údarás na Gaeltachta ag fulaingt de bharr easpa maoinithe. Níl me soiléir cén treo atá sé ag dul ó thaobh spriocanna fostaíochta, cúrsaí forbartha pobail agus mar sin de. Ba mhaith liom go ndéanfar plé arís ar thoghchán Údarás na Gaeltachta mar ní dóigh liom go bhfuil an daonlathas ag bord Údarás na Gaeltachta agus a bhí.
Bhí go leor obair ar pholasaí oideachais Gaeilge agus Gaeltachta déanta ag an Roinn Oideachais agus Scileanna ach ní fhaca muid fós an Bille nua atá chun oideachais Gaeilge agus Gaeltachta a thabhairt chun cinn. Cá bhfuil sé sin? Tá comhchoiste nua le bunú ó thaobh cúrsaí Gaeilge agus Gaeltachta. Caithfidh muide sa Seanad cinntiú go mbeidh ballraíocht ón Seanad ansin. Sílim go gcaithfidh muid coiste dár gcuid féin a bhunú le sin a chinntiú. Ó thaobh mhaoiniú na n-earnáil trí chéile, tá buiséad na Gaeltachta gearrtha siar arís agus arís eile. Dá bhrí sin, bheadh sé fíor-thábhachtach an tAire Stáit, an Teachta Kyne, a thabhairt isteach leis na ceisteanna seo a phlé agus go mbeadh muid chun tosaigh ar an bproiséas buiséid le gur féidir linne, mar Sheanadóirí, brú a chur le go gcuirfear airgead dóthanach ar fáil do chúrsaí Gaeilge agus Gaeltachta sa bhuiséad a bheas le teacht.
Senator Michelle Mulherin: I highlight the shoddy attitude big business can have to the ordinary man and woman and what it is getting away with it. I refer on this occasion to insurance companies, not banks. An elderly woman in my home town was unable to pay her car insurance premium by postal order. She sent a postal order to the insurance company, but it was returned and the company demanded that she pay by credit card. Ultimately, she had to get a family member to supply a credit card number. There is a cohort of older people and people from a certain socioeconomic background who have limited options when making payments. It is scandalous that an insurance company will not accept a postal order, for which a person has presented cash to the post office. This undermines the services provided by An Post. I can give someone a postal order to pay a bill and he or she can lodge it in a bank similar to lodging a cheque. I am bewildered that the insurance company in question would not accept a postal order. This demonstrates haughtiness and the fact that it can get away with it. I would like the new Minister for Communications, Energy and Natural Resources to come to the House to discuss issues affecting post offices, including that of sustaining the network, which is always topical.
I previously raised the issue of trying to stimulate more commercial business for the post office network to make sure it had a future and that it could engage in activities to provide a service for the community.
We want the excellent post office network to remain in place. The Bobby Kerr report was commissioned in order that avenues could be explored and developed to make this happen. I would like the Minister to come before the House to outline the progress made within the working groups and, in particular, to pursue the issue I raised of post offices being allowed to process and handle driving licence applications on account of the new tender procedure being pursued by the Road Safety Authority. This would bring it into line with the system for processing passport applications and create new business. It would be another way to sustain post offices. I ask the Leader to invite the Minister to come to the House because this is an issue that affects the entire country, throughout which the post office network is spread.
Senator Martin Conway: Well said.
Senator Paddy Burke: I support Senator Michelle Mulherin's request that the Minister for Communications, Climate Change and Natural Resources be invited to come before the House to discuss post offices. She raised two very important issues, namely, business being taken away from post offices and the fact that postal orders which are part and parcel of post office business were not being accepted by insurance companies, which is outrageous.
The Senator also referred to driving licences. As we know, there are only one or two locations in each county where people can obtain or renew a driving licence. When the licence process is put out to tender, the post office would be an ideal partner for the centres that issue driving licences. Post offices could process licence applications and then forward them to the licensing authority or office. This would eliminate the need for people to travel 40, 50 or even up to 100 miles to get to a centre where they can renew their licences. In remote parts of the country the post office would be an ideal place in which to process driving licence applications. People would be able to go there with their photographs and applications and have them sent to the licensing authority, with their licences being issued to them in a couple of days or a week. I fully support Senator Michelle Mulherin's request that the Minister for Communications, Climate Change and Natural Resources be invited to come to the House to discuss the viability of post offices throughout the country.
Senator Paul Coghlan: There is concern among people about the VAT rate for the tourism industry. Businesses in Dublin might not need it, as evidenced by the huge increase in the rates charged for hotel rooms here. I admit that there are not enough hotel rooms in Dublin and hope there will be expansion in the number through another building programme. I am concerned about areas beyond the Pale and ask the Leader to use his good offices to make representations to the Minister for Finance on the matter. If it can be afforded, I hope the Minister will be able to ensure, in the forthcoming budget, the VAT rate to which I refer will remain in place. This is very important for the future of the tourism industry. I do not want to refer to Brexit; we will wait to see how matters turn out on Thursday. I would hate to think of what could happen to the tourism industry if the British were to leave the European Union. The value of sterling would decrease; visitors from the United Kingdom are getting great value here at present and we know what would happen otherwise. I hope Britain will remain in the European Union.
Senator Kieran O'Donnell: There are 32,000 homeowners with mortgages that are in arrears for more than two years. It is the elephant in the room for people with homes. I ask the Leader to arrange for the relevant Ministers to come to the House for a wide-ranging debate on whether the insolvency regime is fit for purpose. An appeal mechanism was introduced to allow people to appeal decisions to the Circuit Court. I have heard anecdotal evidence that many homeowners are not availing of this mechanism. Why is that the case? We should have a debate on the matter in the House as the family home is very important. This issue of people not paying their mortgages for more than two years is extremely important. I, therefore, ask the Leader to arrange for the relevant Ministers to come to the House for a debate on the matter.
Senator Brian Ó Domhnaill: Ba mhaith liom ceist a chur ar an gCeannaire maidir le deis a bheith againn díospóireacht a bheith againn ar chursaí Gaeilge go ginearálta, go háirithe i gcomhthéacs Straitéis 20 Bliain don Ghaeilge, an teanga dúchais agus na céimeanna atá á ghlacadh ag an Roinn chun na spriocanna atá leagtha síos sa straitéis a bhaint amach. Ba mhaith liom dá bhféadfadh an díospóireacht sin a bheith againn roimh bhriseadh an tsamhraidh. Chomh maith le sin, the summer economic statement published today makes for positive reading. However, it does not take into account some of the risk factors for Ireland, one of which was mentioned by our Sinn Féin colleague - Brexit - but there are many others, including the financial regulation of banks and many other institutions, some of which were highlighted in the banking inquiry. There are financial, economic, demographic and political risks facing the country. Year on year, we are overspending in the area of health, yet we are unable to meet, from the perspective of the public purse, the demographic challenges posed by an ageing population, whereby up to 4% of the population will need nursing home care by 2025. I, therefore, call on the Leader to facilitate a debate with the relevant Minister or Ministers across a range of Departments on the plans being put in place to meet the challenges posed and ascertain the level of risk across each Department. It might mean many Ministers having to come into the House, but we should be looking at the issue in the context of a five or ten year spending plan. The medium-term objective announced today makes for positive reading, in that it recognises a fiscal space of around €3 billion in 2019. Some of the money will be put into a savings scheme similar to the National Pensions Reserve Fund, but it is not a great deal of money when the challenges mentioned are brought into the equation. I ask that we look at the challenges facing the country and that the Leader consider the best way to debate the issue.
Senator Martin Conway: I join in the call made by the Fianna Fáil group leader, Senator Catherine Ardagh, for a debate on crime. This city has been ravaged by the recent gangland assassinations. We all need to be on the alert to and highlight the issue. The Minister would be welcome to come to the House for a debate on it in the near future and I call on the Leader to facilitate my request.
I also call for a debate on tourism. It is an opportune time to have such a debate, given that the weather has been reasonably good in recent weeks and many more people are visiting the country. I note the concern expressed by my colleague, Senator Paul Coghlan, about Brexit and the potential detrimental effect if the United Kingdom was to leave the European Union. The tourism industry is going well, but we cannot become complacent in any circumstance. I commend RTE for its programme on the Wild Atlantic Way. The scenery is phenomenal and the programme showed the authentic Ireland. The production should be made available to other channels to be shown throughout the world. The programme broadcast last Sunday night was incredible. Tourism has the potential to create thousands of jobs in many parts of the country. We, therefore, need to up our game constantly to ensure the services and facilities provided for those who visit are second to none, that the experience is kept authentic and that we do not destroy it. I would like in early course, perhaps before the end of term, given that we are in the summer season, the Minister for Transport, Tourism and Sport to come to the House to hear statements on tourism over a couple of hours and to outline his vision for its potential development, both in rural and urban areas, in the coming years.
Senator Jerry Buttimer: I thank the 24 Senators who contributed to the Order of Business. Senators Catherine Ardagh and Martin Conway raised the issue of crime, particularly in Dublin's inner city. The success of Operation Thor has shown that crime levels have fallen throughout the country. Any loss of life is to be deplored. I commend members of An Garda Síochána for their vigilance and surveillance last weekend when they apprehended criminals in and around Senator Catherine Ardagh's constituency. The Government is committed to recruiting more gardaí. It has reopened the Garda College in Templemore. There are new gardaí at work, with a target of recruiting 15,000 gardaí by the end of the Government's term of office. Equally, there have been additional resources and moneys for Garda overtime, vehicles and equipment. I agree with the Senators that we cannot be complacent. We must work consistently to tackle crime with all stakeholders. Only yesterday I attended a meeting of the policing forum in Cork city, where the level of crime is down by 53%, which is positive.
Tomorrow the Sinn Féin motion on refuse charges will be discussed. Senators David Norris, Kevin Humphreys and Victor Boyhan raised the issue which we need to see being addressed and redressed. There is no way we can allow gouging or the rip-off of customers by any of those involved in the industry. To be fair, the Minister for Housing, Planning, Community and Local Government, Deputy Simon Coveney, has been working hard since the issue was politicised by some. All of us on this side of the House, as well as those in Fianna Fáil, are concerned to protect the consumer. The model of waste disposal must be changed. As I said last week in the House, we cannot allow a situation where a customer, no matter who he or she is or where he or she is from, has his or her bills increased. Senator Victor Boyhan is correct. People must be cognisant that they have to pay something somewhere and that there is nothing for nothing anymore. That is a fair comment.
Senators Rose Conway-Walsh, Niall Ó Donnghaile, Frank Feighan, Paul Coghlan and Martin Conway raised the issue of Brexit. I join all of them in calling on all those of us in favour of a vote to remain to ensure it is realised in the coming days. It is good that all of the political parties represented in the Chamber today are in favour of that side of the argument. In particular, it is right that we address the North-South issue. Those of us of a particular era have no wish to see the return of Border posts. We have changed and the country is now a better place as a result. The issues of trade, commerce and connectivity are important. The issue of North-South relations is relevant, be it implementation of the Good Friday Agreement, British-Irish relations or working in the institutions. Everyone will benefit from the United Kingdom remaining within the Europe Union in the context of the continuation of the peace process. I hope that in the coming days all of us in the Chamber will exhort a "Yes" or "Remain" vote. That is critical. Again, I implore people to use whatever means they can to urge such a vote. The all-Ireland strategy is one that I embrace and wish to see pursued.
Senators Lynn Ruane and Gabrielle McFadden raised, in different guises, the issue of education. The Minister for Education and Skills, Deputy Richard Bruton, is prepared to come to the House once he receives the Cassells report. I understand it has not yet been concluded and presented to him. I agree with Senator Lynn Ruane on the funding of higher education in that the issues of expenditure and funding are linked. I note that the provision of resources, in the context of universities seeking funding for research and development, has become part of the business plan. The other point made by the Senator is also important. We cannot recreate barriers to third level education and must be open to allowing people to continue to become part of the post-primary school education system.
Senator Kevin Humphreys referred to the Adoption (Information and Tracing) Bill. My understanding is that it is working its way through the Dáil where it is awaiting the appointment of select committees. We can raise the issue of the Criminal Law (Sexual Offences) Bill with the Minister for Justice and Equality.
Senators Terry Leyden and Colm Burke raised the issue of insurance.
Senator Terry Leyden is right. We will facilitate a debate on the issue. Senator Colm Burke made a very important point. He was a member of the body that reported on the issue of medical indemnity insurance. The Government is very concerned about the rising cost of car insurance. The Minister for Finance has engaged with the Central Bank and other stakeholders in examining the issue and is to report back to the Government.
Senator Catherine Noone raised the important issues of cyber harassment and revenge porn. Listening to "Today With Sean O'Rourke" this morning one could not but have been struck by the powerlessness of the strong victim interviewed. Having initially overcome the distress caused, she became empowered and took the battle to the person who was harassing and abusing her. The Law Reform Commission has submitted a piece of work to the Government, but all of us in this House need to see some movement on legislation because this is not just about women; it is also about men. In the era of social media there are cameras on smartphones throughout the world and the issue highlighted by the victim mentioned is one on which many families can testify and to which the Government must have a response.
Senators Gerard P. Craughwell and Paul Gavan raised the issue of child care and in that context referred to the workers before the Law Reform Commission. It is important that those who engage in any process on behalf of the State engage fully and properly. I will take up the issue with the Minister for Children and Youth Affairs, Deputy Katherine Zappone, on the Senators' behalf because it is important that workers, particularly in this sensitive area, receive a hearing and that a solution be found.
Senator Gerard P. Craughwell: I thank the Leader.
Senator Jerry Buttimer: Senator Colm Burke also referred to the committee established to consider the ten-year health strategy. I raised the issue last week in the House. I have spoken to the Minister for Health, Deputy Simon Harris, and hope the other party leaders will write to him with a view to having representatives from Seanad Éireann as part of the committee to have a joint approach taken by the Houses to the ten-year health strategy. This is an important issue and it is important that this House be represented on the committee.
Senator Gabrielle McFadden referred to school building projects. I suggest she submit a Commencement matter on the issue. I agree with her that there is a need for transparency in the school building programme.
Senator Gabrielle McFadden: I thank the Leader.
Senator Jerry Buttimer: Senator Ray Butler referred to small and medium enterprises, as did Senator Maria Byrne. I will ask the relevant Minister to come to the House for a debate on the wider issue of business costs. It is not the case that Sinn Féin has created a policy, rather it is following ours.
Senator Trevor Ó Clochartaigh: Not at all. We called for a review of rates.
Senator Jerry Buttimer: Ours is the pro-enterprise Government party that has worked to create jobs and help people to get back to work.
Senator Trevor Ó Clochartaigh: What did the Leader's party do in the other House for the past five years? It sat on its hands while businesses closed.
Senator Jerry Buttimer: The Senator should look at the employment figures from the time it took office to where we are now.
Senator Trevor Ó Clochartaigh: The Leader's party did nothing on the issue of rates.
Senator Jerry Buttimer: The Senator should ask his local authority members to work with us and our colleagues in government and local authorities to reduce the cost of business.
Senator Trevor Ó Clochartaigh: It needs to finish the rates review first.
(Interruptions).
Senator Jerry Buttimer: What we do agree on is that small and medium enterprises are the country's lifeline-----
Senator Trevor Ó Clochartaigh: The Leader is all talk and no action.
Senator Jerry Buttimer: Unlike the Senator's party, the Government has always been-----
Senator Trevor Ó Clochartaigh: It closed down rural Ireland during the past five years.
Senator Jerry Buttimer: If the Senator and his party had their way, they would tax them to the hilt and not create jobs.
Senator Trevor Ó Clochartaigh: That is nonsense. It is not happening in the North of Ireland.
Senator Jerry Buttimer: We should be serious about creating jobs. If the Senator wants to create jobs, let us do so. The Action Plan for Jobs is testimony to the commitment of this and the previous Government to job creation.
(Interruptions).
An Cathaoirleach: I ask the Leader and Senator Trevor Ó Clochartaigh to respect the Chair. They should not have a-----
Senator Jerry Buttimer: I will happily have a debate on job creation because we have a very strong record in that regard.
Senator Trevor Ó Clochartaigh: I will bring the Senator to Clifden where he will see all of the closed shops.
Senator Jerry Buttimer: Senators Michelle Mulherin and Paddy Burke are right to raise the issue of post offices and to refer in that context to the Kerr report. I agree fully with Senator Paddy Burke that we should be creative in the way we use post offices. I see nothing wrong with his proposal that they be able to issue driving licences It is a very good suggestion.
Senators Paul Coghlan and Martin Conway referred to tourism and in that context what was happening beyond the Pale. I concur with them on the issue of VAT. I stated in the House last week that we had a very good tourism product, the proof of which was provided in the fine programme on the Wild Atlantic Way shown on RTE last Sunday night. The programme was the essence of public service broadcasting.
We should all commend John Creedon and the production crew for the way in which they sold Ireland.
Senator Martin Conway: Great fellow.
Senator Paul Coghlan: Absolutely.
Senator Jerry Buttimer: In tandem with that, there is the important point that the rising cost of hotel rooms in this city and other parts of the country will detract from all the good work being done. The 9.5% VAT rate was introduced to incentivise the tourism industry. Tourist numbers have gone up and it does not endear the travel or the hotel industry to anybody that the cost of hotel rooms is increasing. It makes no sense. I appeal to the tourism industry in that regard. I will bring the Minister for Transport, Tourism and Sport to the House at the earliest time that is convenient for a discussion on the issue.
Labhair na Seanadóirí Ó Clochartaigh agus Ó Domhnaill mar gheall ar chúrsaí Gaeilge agus Gaeltachta. Bhí mé ag caint leis an Aire Stáit nua, an Teachta Kyne. Tá suim mhór aige teacht isteach sa Teach seo chun cúrsaí Gaeltachta agus ár dteanga dúchais a phlé. Tá súil agam go mbeidh a leithéid de díospóireacht againn roimh na laethanta saoire. I hope we will have a debate before the summer holidays on the Irish language and cursaí Gaeltachta. I applaud the Senators for raising the issue.
Senator Trevor Ó Clochartaigh: An-mhaith.
Senator Jerry Buttimer: It is important that there be a proactive campaign on Brexit. I appeal to Senators and would appreciate it if they mobilised people to ensure a "Yes" vote to remain in the European Union.
Order of Business agreed to.
Death of Jo Cox, MP: Expressions of Sympathy
An Cathaoirleach: I understand each group leader or somebody from the group if he or she wishes to contribute has five minutes in which to contribute.
Senator Jerry Buttimer: If the House is agreeable, Members may share time, if they so wish.
An Cathaoirleach: Yes, that is agreed.
On my own behalf and that of all Members, I wish to be associated with the expressions of sympathy on the death of Jo Cox, MP, following an horrific attack as she worked last week. I understand she had won a seat in the general election in May 2015, in the process retaining the seat for the Labour Party and increasing the party's share of the vote. She was a campaigner on issues related to the civil war in Syria and worked tirelessly for refugees. What we should remember about her is that, apart from her political career, she was a mother; she had a husband and children. Her political career was cut very short in an untimely way by this dreadful act, which, unfortunately, could happen to any politician in what we call modern, civilised western Europe. It was an appalling event and without saying too much about it, I offer my condolences to her family, colleagues and friends at this extremely sad time. It is an horrific vista. It is appropriate that the Leader and the House should allow a brief time to allow expressions of condolences following this horrific event across the Irish Sea.
Senator Jerry Buttimer: As Leader of the House, with other Members, I sympathise with the family of the late Jo Cox at this very sad moment. She was a wife, a mother and a parliamentarian. From all we have learned of her since her tragic death, one cannot but be touched by the sincerity of her motivation and her diligent representation on behalf of her constituents. In the wider context, her death must be seen as an attack on democracy. All of us who cherish democracy resent very much the manner in which she was callously killed.
To her husband, children and Members of the House of Commons, we send our deepest sympathy.
Senator Kieran O'Donnell: I wish to be associated with the tributes paid to the late Jo Cox, MP. Like everyone else, I did not know the lady, but from what I have read, she was an excellent parliamentarian. She had previously been head of policy at Oxfam and brought many skills and much experience to her job as an MP. She was going about her daily duties, holding a clinic like any of us, when she was gunned down and stabbed. What happened was an affront to democracy. When I looked through the various accounts in the media, I saw that her husband, Brendan, had issued a statement after her malicious stabbing. He said people would fight against the hatred that had killed her. I want to put the matter in its broader context. In recent years we have seen a terrible polarisation in politics and life. People have been forced to take positions. Being in the middle ground is now seen as something to be frowned upon. This does not do justice to ordinary people. I, therefore, ask that we reflect on the politics we want. We can have diversity, but it should not come down to the physical. There would be no more fitting tribute than if the referendum on Brexit was passed in her honour.
Senator Michelle Mulherin: I also wish to be associated with the expressions of sympathy on the untimely and unseemly death of Jo Cox, MP. It is difficult to exaggerate the shock felt at the sad news of her murder. The big question is why did it happen. When we hear further details, there does not seem to be an answer to that question. We have come so far in the democratic western world, safe in the knowledge that public representatives who are where they are by the will of the people will be safe and not endure physical harm because to do so would be an attack on democracy, the State and the will of the people. The murder of Jo Cox makes no sense. Even after we know more about the killer, it still makes no sense because the democratic process requires us to follow a particular path in order to achieve our goals rather than resort to physical violence which is never the answer. What will it do? It will give rise to another election, which could mean the election of somebody on the same course and with the same political objectives as Jo Cox. It inspires us all to dig deep and hold fast to the concept of law and order, justice, the safety of the person and freedom of expression. That is what we believe civilised beings should do. This meaningless act of violence should prompt us to examine what happens here. I will briefly mention what happened during the height of the water charges controversy and what was visited on the then Tánaiste. My office was petrol bombed. There did not seem to be boundaries to what could be done, particularly in the making of threats. There is a line and if one crosses it, there is a big price to be paid. We must hold fast to this line. Today we think of Jo Cox and her family.
Senator Catherine Ardagh: On behalf of Fianna Fáil, I send our condolences to the family, friends and colleagues of the late Jo Cox, MP. Our sympathy, thoughts and prayers are with her husband and two beautiful children who must be so proud of her. We cannot imagine their heartbreak. This cold-blooded hateful murder was an attack on democracy and an insult to our core human values. As public servants, the act has instilled shock, horror and fear in many of us in the light of the fact that we all have similar routines in our constituencies in doing very valuable work in our clinics.
We join parliamentarians across all democratic nations in sympathising with her loved ones and will remain united against hate and extremism. Jo Cox was a strong and determined advocate for justice and equality and it is incumbent on us to continue her fight. Ar dheis Dé go raibh a hanam dílis.
Senator Robbie Gallagher: I wish to be associated with the expressions of sympathy to the family and friends of the late Jo Cox, MP. No one who has seen video clips of her in the past few days could fail but be impressed by the smiling, bubbly character she exuded. She was someone who had already walked the walk in helping people at home and abroad through her work with Oxfam and in her constituency. I am sure I am not on my own, but I must confess that I had never heard of her before last week's tragic events. While it is important that we hear about her now and appreciate her life, it is sad that she did not receive more media attention while she was with us. Many people have said she was a breath of fresh air in politics and the type of person that they would like to see in politics - positive, generous, hard working, dedicated and so much more. What a fantastic ambassador she was for women in politics. She had so much potential which was cut short. I extend my sympathy to her husband and children, her extended family and friends, her party and all those who knew her. Ar dheis Dé go raibh a hanam dílis.
Senator Rose Conway-Walsh: I thank Senator Michael McDowell and the members of his group for allowing me to contribute before them.
I express my solidarity with the family of the late Jo Cox, MP, and the sympathy of Sinn Féin's Senators to her husband, Brendan; her two young children, constituents and the British Labour Party. She was a mother, sister and daughter whose life was taken in horrific circumstances.
Jo had showed through her previous career of helping terrified and vulnerable people fleeing the most terrible violence in Syria that politics could still attract individuals with sincere motives and the will to work for social justice. Above all else, she was a public servant and a worker who was murdered in her place of work. That in itself is a worrying development for those of us whose daily job means meeting the public. As Seanadóirí and Teachtaí, we are only representatives of the people. It is only through meeting and engaging with those whom we are sent here to represent that politics has any meaningful impact on people's lives. That such a basic function of democracy can come under attack is despicable.
Being on the receiving end of violence and abuse is not the preserve of any political party; public representatives of my party have been shot and killed during the years. What Jo Cox's husband said about sending a message of unity instead of hatred was poignant. Freedom of speech is needed and diversity of opinion must be protected. Robust, passionate debates are an integral part of political life, but the aggressive and violent targeting of individuals because of their opinions or stances on particular issues is wrong and will always be so. This happens at all levels. I was only a short time in local politics when a man entered my office, banged on the desk and told me that if I did not stop my "nonsense" about domestic violence, I would be very sorry. I have received the most vile anonymous correspondence and telephone calls and been subject to bullying on social media. I am not alone in this; many other men and women receive the same verbal abuse.
The role of some elements of the media in inciting hatred of particular politicians is gutter, inhumane behaviour and reflects more on their negative core beliefs and values. This must stop.
This hatred of politicians fostered by some journalists is a huge barrier to many young women and men entering politics. One might ask why any sane person would want to enter the most hated profession in the world. The profession of politics requires a person to stand up for justice and for what he or she believes in, but it also makes him or her a target for abuse. If we are to genuinely honour the legacy of Jo Cox, we must unite against hatred and the vilification of people just because of the political party to which they belong or the views they hold. We must all stand together, across all parties, against this at all times.
Senator Michael McDowell: The death of Jo Cox reminds us how vulnerable the ordinary exponents of democratic politics are as they go about the daily business of interacting with constituents and dealing with the day-to-day detail of democratic life in their community. She was a mother, a wife, an idealist, a pragmatist, an achiever and, above all, before she entered representative politics, a woman who had proved her worth by rolling up her sleeves and becoming involved in real causes for real people.
We are reminded, too, of the fact that politicians are vulnerable. We remember the Swedish Prime Minister, Olof Palme; the US politician Gabrielle Giffords and the former Member of this House, Billy Fox, who lost his life in 1974. Politicians are utterly vulnerable and at the hands of those who put their own ideas before the right to life of others.
I agree with what has been said. We have to set our face against the coarsening of political discourse. We have to vindicate high standards in democratic politics. We must have a society in which no Deputy or Senator in going to his or her constituency office or place of work feels a sense of fear and loathing. We have to have a political system in which no one is subjected to vilification, as the former Taoiseach Brian Cowen was when he attended the Arbour Hill ceremonies, followed by appalling behaviour as he returned to his car as a private citizen, as seen on YouTube. As pointed out by Senator Rose Conway-Walsh, we must have a system in which those who enter politics are not frightened out of it by having their tyres slashed, cars scraped and so forth outside meetings they attend in the course of their work.
If anything good is to come out of a sickening tragedy such as this, it must be that the Members of this and the other House will join in solidarity with the Members of the House of Commons as fellow parliamentarians who associate with each other through various institutions to vindicate real democratic values.
Senator Gerard P. Craughwell: It is with a heavy heart that I offer my sympathy to the family of the late Jo Cox, MP. Sadly, neither her five year old son nor her three year old daughter will ever know the great humanitarian who was their mother. Sadly, her children will not experience the woman who believed motherhood was the greatest joy which surpassed all political ambition. We must ask what crime this beautiful woman had committed. Why was it that she should have had her young life taken? Was it because of the Brexit referendum? That would be an easy answer. We could all possibly live with the idea that some deranged person, driven by passion for one side of the Brexit debate, saw himself as doing a service to the cause. While this hypothesis may have some merit, it does not provide an answer. The truth is we are living in an ever more violent society. Hate is a growing phenomenon in the modern world.
Social media have become the vehicle for some to vent their hatred. Politicians, the religious, sportspeople and others are now subjected to some of the most horrendous outbursts of hate. Since the Brexit debate started, there has been an onslaught of racist commentary. Has anyone in the United Kingdom been charged with incitement to hatred? In Ireland we have laws on incitement to hatred, but they are infrequently used. I would like to refer to one case. A man who had created an extremely offensive Facebook page was prosecuted under the Prohibition of Incitement to Hatred Act 1989 for his online activities. The case which came before the courts in 2011 serves as a useful warning to those who would propagate hatred on social media. People should know that in Ireland the ordinary libel laws apply to whatever is said or published. It is time for us to use the laws available to us to stop this scourge. There can be no room for hate at any level of our society. It needs to be challenged both at home and internationally. I refer, for example, to the gun laws in the USA where some 65 Senators have been described as "spineless" for voting yesterday to reject four measures that would have restricted gun sales, including the sale of guns to people on the federal terrorism watchlist. What does that say about the war on terror which has turned the Middle East into a tinder box of violence?
In Ireland we can do little for the Cox family. We cannot return a loving mother to her children. We cannot turn the tide of hate that led to her death. However, we can resolve to do our bit to challenge hate. We can try to subject those who use hate as a weapon of intimidation to the full rigour of the law. We can try to hold the owners of social media sites which are rapidly becoming platforms for hate responsible for what is published on such sites. We do not need new legislation; we simply need to use what is already available. As we extend our sympathy to the Cox family, let us tell her children that Jo made a difference and gave her life to teach us tolerance. Ar dheis Dé go raibh a hanam.
Senator Alice-Mary Higgins: I would like to share one minute of my time with my colleague, Senator Collette Kelleher.
An Leas-Chathaoirleach: Is that agreed? Agreed.
Senator Alice-Mary Higgins: I join others in expressing my incredible sorrow and shock at the tragic death of Jo Cox following a brutal attack that sent shock waves around the world and extending my sympathy to her husband, Brendan; her two young children; her family and friends; and her constituents and colleagues who have lost a powerful advocate. She brought generosity of spirit, compassion and determination to every aspect of her wonderful life, including her personal relationships, her work for her constituency of Batley and Spen and her career in global development. Her work for Oxfam brought her to some of the most wartorn places in the world. She campaigned tirelessly for humanitarian relief and peace in these regions. She worked across party lines to achieve her goals and never faltered in her determination to improve the lives of the world's most marginalised people. Every life counted in her eyes. She recognised the beauty and potential in every human being, from the refugee children of Syria and the members of communities caught in conflict in Darfur to the women who died needlessly in childbirth. She did her utmost to give a voice to those without one and direct the eyes of the world to issues it would sometimes like to forget.
Jo Cox was a passionate champion for gender equality. She played an active role in the women's movement. Like many members of the Civil Engagement group, she decided to step out of civil society because she wanted to see what she could achieve in representative politics. Her family has described how she entered Parliament because she wanted to be in the engine room of change. She had a respect for the importance of political debate, a determination to translate that respect into meaningful action and a willingness to reach across the aisles to do so. This stands in sharp contrast to the hostile and authoritarian approach taken by the groups the rhetoric of which seems to have influenced her attacker. Of course, there has been deep and widespread concern about the racist and politically divisive motivations expressed in her killing. Surely, therefore, we must heed the message of her husband, Brendan, who has called on us to honour her legacy with a united response against the poison of hatred in all its forms. Such hatred must not be allowed to corrode the political process or public trust in it. Democracy must not be intimidated. Barriers must not be placed between public representatives and the public space in which they represent the people.
I agree that there is a question for the media to look at their role and the language they use. They should use responsible language in how they engage on these issues. It is heartening, however, to see how in recent days so many have chosen to honour Jo Cox with a counter-flow of love and positivity, for example, in the raising of funds for groups such as HOPE not hate. One strong part of her legacy, a powerful legacy of which her children must surely be proud and from which all of us can learn, must be the words of her maiden speech: "We are far more united and have far more in common with each other than the things that divide us." These words must inspire us to closer and more constructive collaboration as parliamentarians, but they must also inspire us as Irish, European and global citizens in a shared world. Yesterday was World Refugee Day. On the streets of Dublin members of United Against Racism marched. In towns and communities throughout the United Kingdom and the world people came together to send a message of solidarity to the 65 million people displaced, more than at any time in history. Jo Cox was a passionate advocate for the people driven from their homes by the scourge of conflict and climate change. She said they had been forced to stay and face starvation and persecution or make a perilous journey in search of sanctuary. One way those of us in Ireland can honour her is by offering sanctuary to the men, women and children who are forced to risk their lives. Europe cannot be allowed to step away from its human rights principles. Let us commit to honouring Jo Cox by working together across all barriers to bring about a more inclusive and equal Ireland and world.
Senator Colette Kelleher: I totally endorse the comments of Senator Alice-Mary Higgins. Recently I was in Beirut in Lebanon. That country which is the size of Munster has welcomed 1 million people into its small part of a turbulent land. We need to step up to the mark in Ireland and Europe. That is the best way we can honour Jo Cox's legacy and values following her tragic death.
Senator Ivana Bacik: I wish to share time with my colleague, Senator Aodhán Ó Ríordáin.
As leader of the Labour Party group in the House, as a female Labour Party public representative and a mother of two young children, as the late Jo Cox, MP, was, I join in the tributes paid to her by others. The shocking and horrific murder of a young talented MP with a bright future in the British Labour Party was an attack on democracy. She was a devoted wife and mother, a keen activist on humanitarian issues and a former aid worker who had spent more than a decade of her life on the front line in aid provision in the developing world. Her death has shocked and moved people in Ireland and throughout the world. Tomorrow would have been her 42nd birthday. My Labour Party colleagues and I are proud to wear a white rose for Yorkshire in her honour. As a feminist, she fought hard for women's rights nationally and internationally. She had an incredible record of activism on a range of issues in her short life. She was director of the maternal mortality campaign to stop women and babies from dying needlessly during pregnancy and childbirth. She had chaired the Labour Party women's network in Britain and was a tireless campaigner for gender equality, as well as on development issues. Others have mentioned her work with Oxfam. She had been its head of global policy, having been an aid worker previously. Since being elected for the first time a short time ago for the constituency of Batley and Spen in Yorkshire she had made some articulate and passionate speeches, from which others have quoted. I believe they will continue to inspire young people, especially women, to enter politics in the future. I have in mind, in particular, her speech in April in support of the Alf Dubs amendment on the need to bring unaccompanied refugee children to Britain.
While the upcoming referendum on Britain's membership of the European Union should not cloud the horrific attack on democracy represented by the murder of Jo Cox, it does have important lessons for us. First, there is a need for respect for the views of others in debate. Probably all of us in this House and people elsewhere have been subject to hate mail, as those involved in public life tend to be. However, I believe her death showed the need to tone down debate. We have seen a recognition in Britain this week that the debate has to become less heated, nasty and violent in tone. As many have commented, the day of her death was also the day the infamous UKIP poster "Breaking Point" was released, reaching a new low in the already ugly campaign being run by the "Leave" side in support of Brexit, a campaign already tainted by racism but which, with that poster, showed a really horrible depth.
Second, Jo Cox's death reminds us that her career and outlook on politics were eminently international. She was a woman who was simultaneously proud of her Yorkshire roots and her constituency of Batley and Spen, but she was also seriously involved in international issues, in particular the need to welcome refugees. This was particularly important at a time when we were seeing the greatest displacement of refugees at any time in history, as well as the impact of climate change and grave issues related to international conflict. She had worked on an all-party parliamentary group on Syria with the Tory MP Andrew Mitchell who was among the many MPs who paid moving tributes to her in the House of Commons yesterday. Our thoughts are with her husband, Brendan; her two young children, Leila and Cuillin; her grieving parents; her sister and family. As her husband said, her death must show us that love is stronger than hate and that what unites us is stronger than what divides us.
Senator Aodhán Ó Ríordáin: I am pleased to join my colleagues, Senators Ivana Bacik, Kevin Humphreys and the entire Labour Party group in the Seanad, in expressing our condolences to the family of the late Jo Cox, MP. I am keen to emphasise what she believed in, which is far more important than what the person who murdered her believed in. She was a person who believed in the human dignity of all individuals, regardless of who they were or from where they came. This is something on which we should reflect because often in Irish society and public discourse we tend to label people and undermine their humanity. This leads to inequality, prejudice and fear.
It is important that anyone who is thinking of entering politics, especially young women, be inspired by Jo Cox and not fearful of what happened to her. We live in an era in which there is harsh public discourse. Sometimes it is difficult to get across a nuanced point of view. Some political campaigns can be quite nasty and personalised. Elements of the media are intent on degrading politics and the public discourse in which we engage. It is important that anyone listening to those of us in this House, the other House or any parliament throughout the world should agree that politics can be the noblest of causes. For a person to follow a campaign and believe in something so vehemently that he or she is willing to spend his or her life or career in pursuit of that aim is good and decent. We must protect public discourse and those who wish to engage in it with everything we can.
I again join my colleagues in expressing sympathy. I am keen to reassure young men and women who believe in politics that the beliefs and values of Jo Cox will win out.
An Leas-Chathaoirleach: I wish to be associated with all of the fine expressions of sympathy.
Members rose.
Sitting suspended at 5.10 p.m. and resumed at 5.15 p.m.
Health Services: Statements
An Leas-Chathaoirleach: I welcome the Minister for Health, Deputy Simon Harris.
Minister for Health (Deputy Simon Harris): I congratulate the Leas-Chathaoirleach on his elevation to even higher office.
I am delighted to speak in the Seanad about my priorities for the health service and in advancing the commitments in A Programme for a Partnership Government in the Government's first 100 days in office. I will be present for most of the debate which will allow me to hear the priorities of Senators. My colleague, the Minister of State, Deputy Marcella Corcoran Kennedy, who leads the public health promotion section of the Department and will join the debate later will also be interested in the views expressed by Members.
Establishing the Committee on the Future of Healthcare was one of the first commitments in the programme for Government. I am grateful for the cross-party and grouping co-operation which allowed it to be established without delay. The Leader of the House has already raised with me the eagerness of Seanad Members to make a contribution to the formulation of the ten-year vision. It is a contribution I would welcome. While it is out of my hands in the sense that it is a matter for the Oireachtas, I hope and trust a mechanism can be found to facilitate the involvement and engagement of Senators in creating a ten-year vision for health care. This presents us with an historic opportunity to achieve something which has never happened before in health policy, namely, a long-term consensus on its fundamental principles. When one talks about ten-year strategies and committees, one can see people rolling their eyes, saying, “Another committee, another strategy.” However, this has never been done before. We have never before set ourselves the challenge of getting every political party and Independent grouping to sign up to a programme setting out where we want the public health service to be in the next ten years, regardless of what happens in elections and politics. If we can reach this consensus together, it will give the public, health service staff and management the certainty that the direction of travel will not change, even if the Government does. When I speak to people on the front line of the health service, they tell me they are not fed up of reform but are instead fed up of seeing a little here and there, with the process never being finished. Part of the reason for this is there has not been consensus. Health Ministers come and go; they tweak the system, but we never allow enough time for a certain direction of travel to be taken.
I recognise some concerns expressed since the committee was established. First, it has been pointed out that the six-month timeframe is ambitious, which I accept. However, it is up to committee members to make it work. Second, a key requirement to make the committee succeed is achieving political and societal consensus on the future of health care. I could not agree more with this objective and it will be a significant first if we can achieve it. When talking about committees and reports, it is important that the process does not create another report to be put on a shelf but actually leads to something tangible behind which we can all get, regardless of who will be in government in the future or what happens in future elections.
Again, I am fully in agreement with that view and the Department will provide every support for the committee in its important work. I intend to second somebody from it to provide support for the committee in carrying out its work.
The central objective of the new Government, as reflected in A Programme for a Partnership Government, is to use the now strengthening economy to make life better for people. During the general election I very clearly heard people stating it was grand the economy was back on track and that it might be improving in some ways but asking what we would do about a range of public services. One of the objectives which all of us involved in various electoral contests heard very clearly concerned the importance of reinvesting in the health service. The Government's objective and mine as Minister for Health must be to improve the public health service on which people depend. It is a service which really matters to families and communities and on which we and our families will depend at some stage in our lives. We all know that the health service faces many challenges. However, I am pleased to state, as Minister for Health, that I am in the fortunate position because of the work of the people to be able to preside over a period of reinvestment in the health service. We saw this last week with the revised Estimate of €500 million for the service. This will help to stabilise its finances in 2016 and the HSE has already stated it will put the health service on a sustainable footing.
It also gives me an opportunity to address some immediate pressures facing patients, as well as meeting programme for Government commitments in the Government's first 100 days in office. These commitments include enabling me to put in place a winter initiative to manage emergency department overcrowding. Work is under way on this initiative. I met the emergency department task force which is jointly chaired by the Irish Nurses and Midwives Organisation and the head of the HSE. At the meeting I asked for input and ideas. I also asked what worked and what did not in hospitals last year and what new measures we could try. I am very pleased that the funding I have secured for the winter initiative is more than the budget for it last year. This year we will have €40 million compared to €33 million last year. I extend the invitation to Senators for ideas, input and any suggestion they think would help to make emergency departments more manageable, particularly during the winter period when we see a spike in attendances. I would very much like to receive them.
It is very important that the initiative focus not just on acute hospitals but also on effective integration between primary care, social care and acute hospital services. We must stop talking about the issues and challenges facing hospitals as though they are just problems in hospitals. I note Senator John Dolan's commitment to disability services. Part of the problem is that people who do not necessarily need to be in hospital or would not have needed to be in hospital find themselves in an emergency department because they could not access a primary care or social care service. Had they been able to do so, they might not have needed to turn up in an emergency department at the weekend, or had the support been in place in primary care or social care services, they could have left the acute hospital when they were ready to do so, rather than finding themselves in the uncomfortable position of occupying a hospital bed when they would have much preferred to be at home in their community with their family. We cannot just talk about acute hospitals on their own. That is why we do not have a Minister of State for primary care services because the Minister for Health is not just the Minister for acute hospitals but also the Minister for all of the health service which very much involves primary care and social care services.
Another integral part of the initiative I am able to announce as a result of the extra funding provided is increasing resources for home care services. As a result of the provision of an extra €40 million for home care services above and beyond what was planned for in the budget, we are not only able to maintain home care and transitional care services at 2015 levels but also, for the first time in quite a period, to increase them. The programme for Government acknowledges the need to improve services for older citizens and the provision of additional home care and transitional care services will assist more older people to leave acute hospitals when they are clinically ready to do so. This will allow patients awaiting admission in emergency departments to be admitted in a more efficient manner. The initiative will also help older people and people with disabilities to remain independent at home and continue to lead active lives in their communities for as long as possible.
I hope the Seanad will note that, in terms of the future direction of health care in the ten-year strategy, one of the specific terms of references is ensuring the effective delivery of primary care service. Deputy Billy Kelleher in the other House likes to remind me of the very valid point that when Dr. Rory O'Hanlon was Minister for Health in 1987, when I was one year old, he used to talk about the delivery of primary care services. We are still talking about it. My colleague, Senator James Reilly, started this process. We must realise it is not just about buildings in the community; it is also about being able to avail of more services in the community. That is why it is an important body of work. To do it, we must recognise that we need to build general practitioner, GP, capacity to respond to patients' needs and the need for expansion of chronic disease management in general practice. Recently I met the NAGP and the IMO to discuss this issue. GPs deserve and need a new contract. We have not had a brand new contract in 44 years. Patients value their relationship with their GP and the State also needs to value it. As in any contract negotiations, the State needs to decide what it needs and what extra, additional or changed services it requires as part of a new contract.
I am very pleased that with part of the additional funding I have secured, I will be able to restore all of the funding to the mental health budget. As Senators know, owing to time related savings - a very bureaucratic phrase - some of the money meant to be spent in mental health services this year was not going to be spent and would have formed part of the base for next year. The additional funding I have secured for the health service means that I am in a position to restore the €12 million diverted from mental health services. We will, under the Minister of State, Deputy Helen McEntee, be in a position to spend on mental health services the full €35 million which had been ring-fenced for them. The Minister of State will develop a plan this year.
We will also be able to invest further in disability services. My colleague, the Minister of State, Deputy Finian McGrath, is working on this. There is an additional €3 million for services for school leavers. An important issue is where young people with a disability who are turning 17 or 18 years and leaving school will go next. As a country, we have not dealt with this issue well and need to do much better. The extra €3 million will help to provide assistance. As part of the additional funding for disability services, there will be more money for emergency placements and to bring disability facilities and residential services up to HIQA and national standards, which is important.
I wish to speak briefly about the need to improve waiting lists and waiting times, with a particular focus on those waiting the longest. It is fair to say that, as a direct result of the years of economic recession, we are seeing unacceptably long waiting lists. We will be reactivating or revving up the National Treatment Purchase Fund, NTPF. The programme for Government commits to providing €15 million for the NTPF for an initiative targeted at those waiting the longest. That funding will come from a continuing investment of €50 million per year to reduce waiting lists. I met representatives of the NTPF yesterday and asked them what they could do with €15 million, how many patients it would take off a list, how the organisation would decide who should be taken off lists and what it could do with a sum of more than €15 million. We are having a discussion on how best the Department of Health can spend the €50 million pledged in the programme for Government for waiting list initiatives. This year we are planning a specific dedicated waiting list initiative through the NTPF which will be focused on endoscopy services. I expect this to mean that the service will be in a position to carry out at least 1,200 endoscopy procedures and to clear the list of those waiting 12 months or longer. This is an important issue which needs to be addressed. I expect to be in a position to formally bring the details to the Seanad quite soon.
I acknowledge that the health service has been changing. It would be wrong not to acknowledge where success has been achieved, but we must challenge ourselves. At what point did we decide that it was acceptable for the political and media norm to be that we would only ever talk about the health service in the negative? This does a huge disservice not just to the Government of the day but also to the 105,000 people who work in the health service. Every day good things happen in it. It is, rightly and absolutely, our job to challenge things that do not go well and highlight problems, but I want to acknowledge the good work carried out in difficult circumstances by front-line staff in recent years. Life expectancy in Ireland has increased by two and a half years since 2004 and is now above the EU average. We have seen a decrease in the average length of stay in hospitals and significant progress in reducing the level of tobacco consumption. It is fair to say Senator James Reilly in his time as Minister for Health continued the good work of previous Governments in driving this agenda which has Ireland leading Europe in tackling tobacco consumption. Progress has been made in many health areas, including in how we deal with cancer and cardiac patients. It is important to recognise this progress, as well as those who work so hard on the front line.
Clearly, there is much more to do, but there is an opportunity to make realistic and achievable improvements in patient care and, therefore, a difference to people's lives. As well as the shorter term initiatives I have outlined, I am determined to progress major investment projects such as the national children's hospital and a new national maternity hospital. I was in the House last week speaking about this issue. We must look at how we can keep the population healthier through the national obesity strategy and the new national cancer strategy.
I want to be very clear. I know that I alone, as Minister for Health, will not fix the health service. While the Oireachtas is very diverse, it need not be divided on every issue.
If we are honest with each other, there is a great deal on which we agree across the Oireachtas in terms of the direction of travel of the public health service, although I acknowledge that sometimes we like to extenuate our differences for political reasons. However, there will always be issues on which we will not agree. If ever there was a unique opportunity to put in place a ten-year vision, it is now because there is a minority Government and we have no monopoly of wisdom or mandate. I am very much in the hands of the Seanad and the Dáil in how we can work collectively together. I look forward to working with Senators on all sides of the House.
Senator Keith Swanick: I welcome the Minister to discuss important issues regarding the health system. As a GP based in rural Ireland, I would like to outline some of the issues in primary care, which is a crucial aspect of the health sector. I commend the Minister for his support of the ten-year consensus on health care provision. It is a hugely promising step for the Government which will refocus the discussions on health reform in this and the Lower House on patient care rather than political gains. I also commend the Minister for his recognition of the role of general practice. International studies demonstrate that the strength of a country's primary care system is associated with improved population health outcomes, regardless of the per capita health spend and percentage of elderly patients. Furthermore, the World Health Organization, WHO, has reported that increased availability of primary health care is associated with higher patient satisfaction and reduced aggregate health care spending and that orientation towards a specialist-based system enforces inequality in access.
The time has come for all stakeholders to work together in a pragmatic and solution-driven approach to develop a ten-year plan to reform health care. I welcome Senator Colm Burke's comment on Senators being members of the relevant committee. There is a need for better integration of primary and secondary care services. This approach is supported by international evidence that it would deliver efficiency and better patient outcomes. For every €1 spent on primary care €5 is saved elsewhere. This model works in Kilkenny, with the success of the local area integrated care committee and acute medical assessment unit. Kilkenny provides an example of what is possible in the integration of primary and secondary care services, resulting in shorter patient waiting times and GPs being given greater access to diagnostics. That would prevent the patient ending up in the wrong place at the wrong time. Patients often self-refer to emergency departments, for example.
There is a manpower crisis in general practice. A total of 157 GPs are trained each year, but we are exporting half of these highly trained professionals. An Irish College of General Practitioners survey in 2014 of trainees and newly qualified GPs found that only 37.5% of GP trainees were definitely planning on staying and working in Ireland and that only 43% saw themselves as a principal in a GP practice or partner in a group practice. An option for the remainder was working as employees in salaried posts. In the current climate, however, few existing practices have the finances to do this. While training more GPs is necessary, until an environment that encourages those who are trained to stay is created, we cannot begin to resolve the looming manpower crisis.
A further concern is the ageing demographic of the GP workforce. A report commissioned in 2015 by the National Association of General Practitioners, NAGP, by LHM Casey McGrath found that more than 900 GPs - close to one third of the workforce - had expressed an intention to retire or emigrate in the following three to five years.
In general practice 22 million consultations are carried out per year, with a greater than 95% satisfaction rating. This figure is expected to increase to 35 million annually in the next three to five years. The projected number of GPs needed to meet this demand is approximately 4,000. Approximately 2,400 GPs have GMS contracts, but given projected retirements in the next few years, we stand to have only half the required number. However, we regularly hear from GPs who have emigrated to Australia, New Zealand and Canada. They highlight consistently that the major difference between the Irish health care system and the systems in the countries mentioned is timely access to diagnostics such as X-rays, scans, physiotherapy and counselling services and expert opinion and the difference it makes to their working day and the benefit to their patients, which cannot be overestimated. In recent years the State has rightly built primary care centres. However, it is not all about bricks and mortar. It is important that activity take place within the centres to keep patients out of the secondary care system.
Ultimately, many of the challenges faced by GPs boil down to the terms and conditions of our working lives which are dictated, as the Minister said, by an ancient contract between the State and the HSE. I hope he will confirm in due course that the NAGP will be invited to negotiate a new contract on behalf of its members. I believe he had a constructive meeting with the association's representatives last week and welcome his commitment to engage further with them in the coming weeks. The organisation has made significant gains in progressing key issues for GPs since its relaunch in 2013.
On the Supplementary Estimate for health, Fianna Fáil welcomes the allocation of an additional €500 million, with €40 million for home care services, €31 million for disability services, €20 million being ring-fenced for mental health services and €40 million for the new winter initiative. Should the Oireachtas joint health committee hold extensive hearings with the Department and the HSE on what is required to meet both the demographic demand and unmet need in order that all proposed expenditure can be fully examined and scrutinised? In particular, the HSE should be invited to make a submission to the committee similar to that sent to the Department last August in order that health expenditure requirements can be debated extensively and analysed in advance of the budget in October.
Senator James Reilly: I congratulate the Leas-Chathaoirleach on his recent election to the post. I also congratulate the Cathaoirleach who is not present on his appointment because this is my first opportunity to do so publicly. I also congratulate the new Leader of the House, Senator Jerry Buttimer, and all new Senators on their election.
There is much I would like to say, but I agree with everything Senator Keith Swanick said, much of which I said in the past. I am also delighted to have heard the Minister speak in the manner he did. It is important, as we celebrate the centenary of the 1916 Rising which started a process that led to our independence, that we remember what the Proclamation states about equality and treating all citizens equally. One of the most pressing needs when it comes to equality concerns the right to access health care when one needs it, not when one can afford it. That has been at the core of what we have been seeking to do. The ten-year plan and the cross-party committee will decide what it is we want. Many agree on the what but it is the how and the when that cause divisions. We want a fair health service that treats everybody equally and that will be available for them when they need it.
The points I wish to make I have made in the past. I always had the mantra that the patient should be seen at the lowest level of complexity that was safe, timely, efficient and as near to home as possible. The nearest place to home is usually the GP's surgery. We need primary care centres to deliver the excellent care GPs can provide in excellent surroundings. That sends a message. I agree that greater access is needed to diagnostics, but it also needs to be ensured people are working to the level of their competence and that GPs are not seeing patients who could be seen by nurses, that nurses are not seeing patients that should be seen by other paramedics and that consultants are not examining patients who could be dealt with within the primary care system. There is a huge opportunity with a new cadre of nurses coming through who are interested and energised, want to provide different services and are well capable of learning these skill sets.
No part of the health service is isolated.
Senator Keith Swanick addressed this issue. One cannot fix what is happening in emergency departments unless one fixes what is happening in primary care services which equally are dependent on what is available in the community. The full circle is completed by rehabilitation services.
Senator Keith Swanick talked about elderly patients. I am very concerned about the fact that there has been a movement towards the use of a medical model in nursing homes which was arrived at by the need to address the burdens on families and society and concerns surrounding the safety of elderly people living on their own, as opposed to providing a service and a place where we address their needs and help them to get the best out of life as they inevitably become more frail. That is something we must readdress continually.
I was also struck by the Minister's comments on disability services. Senator John Dolan would be the first to say people with a disability often ask, "Why am I here? I am not sick; I have a disability." It is an entirely different problem. We must address this big issue which has always caused huge tension between the excitement of investing more in cardiac bypass procedures and stents and longer term investment in education on exercise, obesity, alcohol and tobacco. That dynamic is always present and one that is very difficult for politicians to address. I have been critical of politicians on this island, elsewhere in Europe and at the United Nations for being more likely to go for the big bang of the new cardiac unit rather than the slightly softer option of providing more PE classes in schools, promoting exercise and education in order that people will realise one can prevent many illnesses. Dying from infections is no longer a threat in the western world; the big threat is posed by chronic illness and non-communicable diseases. The broader issues surrounding this are influenced by child care services, for which we must have a vision. The Government has started on that route in making child care more affordable, giving every child an equal chance in life. Again, that is the big problem for us. We all know the things we want; we all speak to them, but we must acknowledge that funding is finite and that if we invest here, we cannot invest as much over there. I, therefore, return to the argument about the provision of a new CAT scanner versus the introduction of a new public health initiative.
I congratulate the Minister on his appointment and wish him well. I will be as supportive as I can possibly be. I encourage him to pursue the issue of the establishment of a patient safety authority urgently. It was to be advertised before I left office, but then it suddenly changed into something else. We still have no patient advocacy agency in the country, although we need one. I often said when I was Minister for Health that I often felt that I was actually the Minister for ill-health because it was all about disease, illness and sickness. There was no emphasis on the need to keep people well and encourage men and others to go to see their doctor early when there was something wrong.
I wish the Minister and the committee well, but I echo strongly the request made by my colleague, Senator Colm Burke, that there be Seanad involvement. We will miss out hugely if we do not have it.
Senator Victor Boyhan: I will be very brief. I congratulate the Minister on his appointment and thank him yet again for coming to the Seanad.
There is not much of a mention of the National Treatment Purchase Fund in the programme for Government. In the past it was demonstrated to be a very able, efficient and focused group. Under the new Government arrangement, it was somewhat tapered and called the special delivery unit within the Department of Health. It was a stand-alone operation in Tara House on Tara Street. I do not know whether it has been subsumed into the Department, but there is room to explore and consider its capacity to access really good competitive deals in both the private and the public sectors. Let us not fear the private sector and the synergies between the private and the public sectors. What people want is fast treatment. The person who has been waiting the longest needs to come first. That is the issue. I would, therefore, like the Minister at some stage or other, not necessarily today, during one of his trips to this Chamber to elaborate on the role and the potential for expansion of the National Treatment Purchase Fund.
Senator Colm Burke: I welcome the Minister. I am delighted that he is here with us dealing with the health programme, in particular the need for a ten-year development plan, which is extremely important.
One of the things that concerns me about the health care sector is that on every issue that comes up in the media the content seems to be very negative, whereas there are many positive things to be said, to which the Minister referred. It is interesting how the report of the HSE was made available and laid before this House in the past two weeks, yet it received very little coverage. I remember being at a meeting not so long ago at which people were saying the health system was crumbling. I asked them what particular aspect was crumbling, but the debate went on.
I started to look at the figures to see what exactly the health service was doing. Last week I raised the issue of attendance at outpatient clinics in hospitals. There were 3.3 million attendances which, over a five-day week - most outpatient clinics operate five days a week - worked out at 63,000 patients per week, or 12,500 per day, which is a huge number. If one considers emergency departments, it works out at approximately 23,000 patients per week. The question is how we can work towards making the services provided more efficient but also, particularly in emergency departments, how we can work towards reducing the numbers in order that services would be available outside the hospital system.
My colleague, Senator Keith Swanick, made very important points about GPs and the support provided for them. It is also important to realise that in recent years GPs have suffered unfairly in the making of cuts. I remember meeting a number of GPs in the past 12 months who identified the fact that they had suffered cuts of up to 40%. I am not exaggerating the figure. As a result, they find that they cannot provide the level of service they want to provide for their patients. I was given one very simple example. If someone comes into a surgery and needs three stitches in his or her arm, the pack costs €30, but the GP is only entitled to claim €26 outside of the time he or she gives in providing care. The easiest option, therefore, is to refer the person concerned to an emergency department. That is just one example of what I am talking about, namely, the inadequate support given to general practitioners.
I agree with Senator Keith Swanick in what he said about the National Association of General Practitioners. All of the medical unions should be involved in negotiations on the contract for GPs because it is not a contract for 12 months or two years but one which I hope will be in place for a long time, possibly five, ten or 15 years. Therefore, it is important that all those involved in providing medical care be involved in considering what the contract should contain.
We face a number of major challenges, of which I think the Minister is aware, as he has highlighted them. A simple example given at a presentation by GPs that I attended was that there were approximately 600,000 people over 65 years of age in Ireland. Within 14 years that figure will increase to 1 million. A very interesting figure is that 51% of all hospital beds are occupied by patients over the age of 65 years. If one works out the ratio, the number of additional beds that will technically be required in the next 14 years is quite substantial, unless we can make improvements in a number of other areas to make sure we will have fewer people going into hospital and that the care they will require can be provided outside the hospital setting. The budget for the HSE last year was €13.895 billion, of which €3.621 billion went to non-statutory agencies.
In addition, a huge amount is spent on private health care such that in the OECD Ireland is now the second highest spender on health care per head of population, but are we getting value in real terms? Could we deliver a better service with the money being spent? I believe we could.
Another issue we need to consider and which should be part of the health plan, although many may say it should not, is medical education, on which we are spending about €90 million per year. Within 12 months those who benefit from 60% of that investment will have left the country. We need to look at how we can keep our own within the health service and if they do want to go abroad for a period, we should at least be able to bring them back. This is affecting smaller hospitals, in particular. In hospitals outside the major centres of population, Dublin, Cork, Limerick and Galway, up to 70% of medical practitioners are non-Irish. They are providing a good service, but we should have a system in place that encourages Irish people to stay in Irish hospitals.
Senator Rose Conway-Walsh: I thank the Minister for attending and I will be really positive. I thank the Government for its investment in Áras Deirbhle in Belmullet because for many years there was no investment in the nursing home. This is hugely important in the context of what I am going to say.
In the light of the negative impact on rural areas of centralising and privatising health care services in Ireland, Britain and many other countries, will the Minister consider a proposal to provide as many such services as possible in rural and urban settings? Sinn Féin and I have long believed a new approach is necessary to overcome the challenges met by those living away from large hospitals and acute specialist hospitals in accessing health care services. This growing problem is not confined to those living in remote rural areas, although the lack of transport and a good road network and the cost involved in accessing the most basic services is greater in these areas, including where I live - Erris, County Mayo.
There is a really good strategy, Developing Community Hospitals, in use in Scotland; there is, therefore, no need for us to reinvent the wheel. The Minister may be familiar with Belmullet hospital where, under the then Fianna Fáil Government, half of the beds were closed in 2010. We led a very active campaign - Senator Michelle Mulherin will testify to this - to try to keep them open. However, the then Government insisted on closing them. We are left with the infrastructure of a large hospital that could be used as a centre in the delivery of the services we need. Will the Minister consider initiating a pilot project to develop a multidisciplinary health service facility at the hospital and having a cost-benefit analysis carried out to deliver it? We could lead the way in examining whether it might be a method of tackling the shortfall in the provision of services between centres of excellence and acute centres. We could look at the possibility of providing a community casualty unit to prevent people from having to travel elsewhere to have minor injuries treated. We could examine the development of an electronic health records system in order that patient information would be available, provided proper broadband services were available. We could also revisit the development of technology which never happened but which was promised under the primary care strategy. The Minister will recall the pilot projects established in that context. The major problem with them was that proper resources were never provided for them. Putting a sign with the words "Primary Care" above a door does not make a facility a primary care centre. Investment is needed. The potential identified within the centres could be used not only to provide primary care services but also in the development of multidisciplinary health service facilities. We could test this model in Belmullet to discover if it would work. Using this model many safe and effective services could be delivered at local level. We could have an integrated patient transport policy included. My direct question to the Minister is whether he would be willing to look at this issue and work with us in the community of Erris in Belmullet to test this model to establish whether it would work in other areas of the country also.
Mr. Simon Stevens, head of the NHS in England, realises there are many shortcomings in the centralisation and privatisation of health services. The way in which the health system has developed has left us in a situation with which none of us agrees where the treatment provided is based on where one lives. Whether a person lives or dies can come down to where he or she lives. People living in areas such as the one in which I live are at a major disadvantage in trying to access services. I remind the Minister that patients from Belmullet who are seeking to access the most basic services being delivered in Galway are obliged to make a six-hour round trip. Some may have to attend two, three or four appointments in one week. That is not the way to treat some of the most vulnerable patients, namely, those who are ill and require to access health services.
I ask the Minister to examine the Cuban model of delivery. It is very interesting. It delivers an excellent health care service to a population of 11 million for less than what it costs to deliver services at Beaumont Hospital.
Will the Minister comment on the ESRI report on the possibility of universal health care delivery, particularly as it has long been our policy? It has often been ridiculed on the basis of the argument that we cannot afford it. We have always said we could afford it and it is interesting to have the evidence to back this up.
I look forward to working with the Minister and hope he will have an open-door policy in addressing all of the issues to which I have referred. I ask him to consider the impact on the health service of the policies of previous Governments and how they have militated against those living in rural Ireland, in particular.
Senator Michelle Mulherin: I welcome the Minister and wish him well. I also welcome his statement on the future of health care. While ten years seems to be a long time, what is significant is that he referred to bringing all sides on board and obtaining different views on how we might achieve a more desirable health care system for everybody. This will require dialogue which will take place in the context of increasing demands on health services. People are living longer and coping with chronic health conditions. With advances in medicines, there are available new drugs and new treatments for cancer and other life-threatening illnesses and diseases. Periodically, the debate to the effect that the State is required to fund new drugs is played out in public. The pharmaceutical companies are trying to obtain top dollar, while the State has to watch its budget. These are the realities, but all the time we are talking about human beings.
It is worth remembering, even as we try to deliver them, that health care services must be provided for everybody, regardless of a person's finances or what he or she can afford. If someone is sick or dying, he or she does not have any option. It is at this time that he or she is really vulnerable. If the State is worth anything, it must continue to strive to find ways to make the provision of health care services a reality for all citizens. I know that the Minister is committed to doing this.
I welcome the convening of the new committee on the future of health care. I support Senator Colm Burke's suggestion that Senators be included among its membership in order that the Upper and Lower Houses will be represented on it.
I welcome the opportunity to tease out the issues and get down to the nuts and bolts of the debate.
I ask the Minister to intervene in a pressing issue that has arisen in Ballina District Hospital, County Mayo, namely, the escalation of an ongoing dispute between WestDoc which provides the hospital with an out-of-hours general practitioner service and general practitioners who provide the service during normal hours. These services provide 24-hour cover and allow the hospital to function. I have been informed by staff of a threat to withdraw general practitioner services from the hospital in the coming days. This would result in the closure of the hospital, which is difficult to believe. The staff who contacted me are very concerned about patient care. Ballina District Hospital is a step-down facility with a large number of elderly, frail patients. It provides a top-class service, as everyone who uses its services will attest. People are delighted with the care and attention they receive. The hospital's closure would lead to 59 patients being transported by ambulance to Castlebar General Hospital. Staff are also fearful for their jobs. While discussions are ongoing, the dispute appears to be escalating and a threat of withdrawal of service has issued to the Health Service Executive. I ask the Minister to ensure all obstacles are overcome and that the parties will move towards finding an immediate solution to the dispute.
I commend the general practitioners who provide a very good service for the hospital. I also commend hospital management with which I worked closely to have all beds in the facility reopened. In 2011, when the previous Government was elected, the number of beds in the hospital had declined to 40 and it was feared that there would be further bed closures. Working with the Minister and the Health Service Executive, managers at the hospital and I fought long and hard to secure the reopening of beds and the expansion and renovation of the hospital. In conjunction with the Mayo Roscommon Hospice Foundation, for the first time Ballina District Hospital provides hospice suites. A great deal of good work has been done at the hospital and it is a matter of grave concern that it may close. Such a scenario would be unacceptable and have knock-on effects. Mayo General Hospital, like all hospitals with an emergency department, suffers from the problem of requiring patients to wait on trolleys. Ballina District Hospital and hospitals in Swinford and Belmullet which also provide step-down beds provide a lifeline for Castlebar General Hospital by relieving pressure on its emergency department. I would appreciate it if the Minister reverted to me on this extremely urgent matter. The parties involved must sit around a table to knock out a solution in the interests of health care provision in the region.
Senator John Dolan: The Government must adhere to the timeline for ratifying the United Nations Convention on the Rights of Persons with Disabilities by the end of the year. Work is being done on the legal and legislative changes required for ratification. In parallel, implementation planning is needed for the urgent restoration of practical measures such as home supports, personal assistance, neurorehabilitation services and therapies and so forth. Previous speakers referred to other measures and many more come to mind. The mobility allowance is dangling by a thread and the motorised transport grant was abolished. Budget 2017 which will be introduced in four months will indicate whether there is a willingness and an ambition to move beyond words in terms of the importance of the inclusion of people with disabilities.
Not to put a tooth in it, the question being asked is whether the long-running crisis in disability and mental health services will continue to be viewed as acceptable. These areas of health care have not been adequately addressed for decades. Austerity measures have brought a vicious and continuing harvest of poverty, exclusion and loss of hope to people with disabilities and their families. The restoration of services lost is the immediate priority. We must proceed on a programmatic basis thereafter.
The ten-year plan announced by the Minister is very welcome. I will make a couple of points about some of the relevant issues and tensions.
Every year we have what are described as the "new disabled". At least 50,000 people will become disabled or require disability or mental health services this year. Disability is, therefore, a societal issue. We do not have disabled people and the rest of us because disability can and will come to everyone's door. Reference was made to an increase of 2.5 years in longevity in the past 12 years, which is a significant improvement. While mortality rates have declined significantly in the past 20 years, morbidity rates have increased. The ten-year plan is extremely important because we should have been planning decades ago. Let us start to address demographic changes such as longer lifespans and an increase in the number of people living with disabilities and other conditions that reduce their capacity. People with disabilities and their families have been paying the price for the failure to plan.
As people move out of institutions, others, often young men and women, are moving into nursing homes and other institutions. Some health programmes receive statutory support, while others are provided on an administrative basis, for example, personal assistants, home help services and so forth. This has allowed these services to be filed away for the past decade.
The Department of Health has always been the default service provider for people with disabilities. When people require education, employment activation, accessible transport, housing and so on, it is regarded as a health issue because a disability is involved. However, they are issues for the relevant Department, whether it be education, housing or transport. I ask all Senators to think about this matter because the Department of Health has always been at the short end of the problem. Other Departments have primary responsibility within their remit for the lives of people with disabilities and their families. It is long past time that they faced up to this. The nature of disability is changing. At one time the narrative was that there were people with disabilities and able-bodied people. That is no longer the case. We are all on the slippery slope. As a result of improvements in health care and social service provision, many people have what I describe as disabling conditions such as those of an episodic nature. We must reconsider our approach to these issues, which will mean ensuring Departments other than the Department of Health share the burden. Enabling measures are required to keep people at work and ensure young people will move from education into training and employment. Budget 2017 will be the first critical step to be worked on.
How did the 50,000 people who will become disabled this year view budget 2016? Most will have asked whether their income had improved or they or their families were better off as a result. This year, however, the same people will view the budget from the perspective of having a disability and will ask whether they will be able to remain in employment, secure a job or continue to function as a parent, look after elderly parents or engage in the community.
I have three requests. First, the ten-year plan must strongly factor in disability and mental health services and find ways to draw in community organisations and groups working in these areas. Second, budget 2017 must provide for the restoration of services.
Third, we must focus on community living and participation. Other Departments and public bodies must get their act together and not leave everything to do with disabled people to the Department of Health.
Senator Maura Hopkins: I thank the Minister, Deputy Simon Harris, for addressing us. I welcome the Minister of State, Deputy Marcella Corcoran Kennedy, to the debate.
Like my colleagues, I support the setting up of a cross-party committee on the future of health care which will have a longer term focus on health policy in the next ten years, which is welcome. During the recession health budgets were hit but now that we are in a better economic position it is important that we direct resources appropriately towards the fairer delivery of services.
I would like to refer to many issues within the health service, but I will focus on stroke care. The suddenness of a stroke can be very difficult for patients, families and carers. The effects range from very mild difficulties such as hand weakness to more complex challenges such as speech difficulties, sight loss and paralysis on one side of the body. As an occupational therapist who has worked specifically with stroke patients for the past eight years, I become deeply frustrated when, following a stroke, many patients are unable to gain access to specialist rehabilitation services in a timely manner. There is the potential for these patients to improve, given access to the right services. An audit report on stroke services carried out by the Health Service Executive, HSE, and the Irish Heart Foundation published in January this year found that the death rate had dropped from 19% to 14% since the last audit had been carried out in 2008. Some 8% of stroke patients were being discharged to nursing homes compared with a figure of 15% in 2008. That is a substantial reduction, which is most welcome.
The Minister has rightly said there are good developments every day within the health service and these changes are very much driven by the HSE national stroke programme which is currently led by Professor Joe Harbison who has shown great leadership in the reorganisation of acute stroke services. The position has been improved from having one stroke unit to 21. There are approximately 250 medical doctors trained in thrombolysis or clot-busting treatment. That means that real improvements are being made in the initial stages following a stroke. However, stroke remains Ireland's biggest killer after cancer and heart disease. Stroke patients must be treated with the same level of urgency as cancer and heart disease patients. The key finding of the audit was that a very high proportion of survivors suffered needless disability. I listened attentively to Senator John Dolan's contribution because there is a lack of rehabilitation services once they have been treated in hospital for a stroke. With medical advances, we must have better and more timely access to rehabilitation services. It is important to consider such services within the context of community and hospital services for those under and over 65 years of age.
The audit shows that only about half of patients are admitted to a stroke unit at any one time during their hospital stay. In 2016 treatment in a stroke unit is the most basic requirement. All of the clinical evidence supports the benefit for stroke patients. Treatment in such a unit improves their outcomes and recovery. For patients under the age of 65 years, the position is of even more concern. These patients find it extremely difficult to gain access to inpatient rehabilitation services because the only service is provided by the national rehabilitation service in Dún Laoghaire. Many patients wait for months. We need to make sure multidisciplinary teams are properly resourced.
One of our major challenges in providing rehabilitation services is the delivery of more units. I ask the Minister of State to ensure the specialist rehabilitation unit planned for Roscommon County Hospital will be progressed as quickly as possible. It is essential that the project team which comprises hospital, clinical and estates personnel be assembled as quickly as possible. I ask the Minister of State to ensure that that will happen without delay. We must ensure we provide proper services for the people of the west who find themselves in a very difficult position when they require rehabilitation.
On early supported discharge services, I ask that there be a greater focus put on community care and properly resourcing early supported discharge teams.
Acting Chairman (Senator Michelle Mulherin): I welcome the Minister of State, Deputy Marcella Corcoran Kennedy.
Senator Gerald Nash: I am pleased to contribute to this important debate. First, I wish my colleague, the Minister of State, Deputy Marcella Corcoran Kennedy, every success in her portfolio. In the previous Oireachtas we both had different roles, but I very much enjoyed our engagement in my role as Minister of State with responsibility for business and employment and hers as the very successful Chairman of the Joint Committee on Jobs, Enterprise and Innovation. I also extend my congratulations to the Minister, Deputy Simon Harris, on his appointment. It is not overstating the case to say that as a society we very much depend on their success as Ministers. There is, therefore, no extra pressure.
For some time I have been stating privately and publicly that the future direction of the national health service requires a long-term, consensus-driven strategy and approach, with a genuine role in the process for all stakeholders. That means that everybody across society, not just those of us who are privileged to sit in this and the Lower House. The success of this proposition and the proposed ten-year programme for health services requires all of us to be honest with one another. It requires an honest Government but also requires an honest Opposition. We need to start with a vision for the kind of health service we want to see provided. It follows from this that we must be absolutely clear on how we plan for and resource that service. We, therefore, need to have an honest discussion.
The provision of first-class health care comes at a cost. It is very costly, but it is something that is worth paying for. Treatment in acute medical settings is particularly expensive and the operation of emergency departments is, by definition, very costly. Those of us who have and will have a need to use acute hospital services deserve to be treated in a timely and effective manner and provided with the best possible treatment by staff who are supported and valued in hospitals that are accountable and managed by people with the right skill sets and who understand it is the patient, the citizen, who should be at the heart of health care service provision. They should also accept that their jobs and the way in which they manage them in hospitals should be open to the closest of scrutiny.
We are also familiar with the problems experienced in overcrowded emergency departments across the country. I am acutely aware of the long-standing problems experienced in Our Lady of Lourdes Hospital in Drogheda, my home town.
I have been party to many efforts, particularly in recent years, to address the hospital's multifaceted overcrowding problems. We need to step back and take a clear-headed look at this issue. Many of the problems experienced in emergency departments and the reason for the bottlenecks in the making of appointments, outpatient services, surgery and so on in acute hospitals can be traced back to the lack of prioritisation of the provision of integrated primary care services and the notion of prevention being at the heart of the life of a healthy society. Remarkably, Ireland has the only health service in the European Union that does not offer universal coverage for primary care services. We have a public hospital system that is largely fed by a private primary care system. This is the perverse way in which the health system has evolved organically since the foundation of the State. Many sneered at the idea that we would provide free GP care for young children and those aged over 70 years. It was dismissed by some as a political stunt, but it was the start of an ambition to provide such a service for all citizens in a move towards a new national community health service. My party's vision for a new integrated primary care service involves the proper integration of GP services, advanced nursing practitioners and allied health professionals and staff being active in community settings treating and managing patients away from expensive hospitals.
If we believe the pressure on hospitals is enormous now, what will it be like in the years to 2020 and 2030 when it is anticipated that there will be a 40% increase in the incidence of chronic disease in Ireland? To avoid this apocalyptic scenario, we must develop dozens of new community-based clinical programmes that will target the most prevalent and complex chronic diseases in order that people will have consistent access to treatment and prevention strategies without needing to visit hospitals. This approach would have an empowering effect on patients, liberating them from excessive reliance on the acute hospital setting.
We cannot afford not to make these step changes in the delivery of services. It is important that we put the primary care vision and the integration of services at the heart of everything we do in our vision for the health service in the coming years. We can build consensus on this approach.
Senator Martin Conway: Cuirim fáilte roimh an Aire Stáit go dtí an Teach. I apologise for not being present for the earlier part of the debate. Unfortunately, I had to honour a prior commitment.
I welcome the Minister of State, Deputy Marcella Corcoran Kennedy. I have known her for a long time and know of her passion and commitment to public service. She has hit the ground running in what is an interesting, challenging, fruitful and rewarding portfolio. There will be tangible successes as a result of the personal commitment she brings to everything she does. In the previous Oireachtas she worked on the justice committee. It is an exciting prospect.
It is appropriate that we debate the health service in the first weeks of this Seanad. It is welcome that a new conversation is developing. I have always adopted a positive approach to politics, even in the most difficult of circumstances. If we engage, are positive and seek consensus, we can achieve much. If we divide, we will be conquered by outside forces. If we unite, we can conquer.
I was heartened by the commitment in the programme for Government to agree a ten-year plan for the health service. The Minister for Health, Deputy Simon Harris's first public comments after his appointment were in that vein. He wanted to reach agreement and set up an all-party Oireachtas committee to devise a strategy for the next decade. That is appropriate, as health care is not a political football but a political issue. For too long, it has been a political football and all sides in the Oireachtas are to blame. We have seen the vulnerability of the health service and used it as a political football to gain traction in opinion polls, notoriety and votes, but that is not an appropriate approach to the health service and for the millions of people who depend on it.
We spend much less on health services per capita than many other countries, including, for example, the Netherlands and Germany. It is claimed that it is not a question of finances but of how resources are spent within the health service. I contend that it will remain a financial matter until such time as we realise we cannot have first-class health services if we continue providing for tax cuts in budgets, but that is a difficult political decision to make. It is easy to knock 0.5% or 1% off various tax rates and in so doing put more money in people's pockets which everyone likes and to which everyone aspires, but it means that there must be give elsewhere. I would prefer to see no tax cuts being made and instead the money being put into the health service to restore much of what has been removed in recent years.
We in this House have a role to play in the formulation of the ten-year strategy. I am unsure whether a select committee is being set up by the Minister to formulate the strategy; I hope not, rather I hope it will be an Oireachtas joint committee. Some Senators have vast experience in this sector. Senators Keith Swanick and James Reilly are GPs, while Senators Joan Freeman and John Dolan have experience of implementing health services and dealing with related issues, for example, mental health services and in dealing with persons with disabilities, etc. They want to serve, make a contribution, engage and be involved in the formulation of the ten-year strategy. No one expects everything to happen instantly - it will happen incrementally - but the best way to ensure we will have a health service over which we will be able to stand and of which we will able to be proud some day is by agreement, consensus and pulling all of the expertise and various strands together.
The position on emergency services in the mid-west from where I come can only be described as diabolical. Reconfiguration happened, even though facilities were not in place to handle it. The 24-hour emergency departments in Nenagh and Ennis hospitals were closed and services consolidated in Limerick where there were no facilities available. The service is collapsing. Consolidation and reconfiguration should not have happened until such time as the new emergency department had been built and opened. I am glad that we will have a state-of-the-art emergency department in University Hospital Limerick in 2017, but reconfiguration put the cart before the horse. It was bizarre.
The medical profession-----
Acting Chairman (Senator Michelle Mulherin): I am sorry, but the Senator is over time.
Senator Martin Conway: This is an important point. The medical profession and all stakeholders have responsibilities. There is anecdotal evidence of GPs referring patients unnecessarily to emergency departments. The committee that is being formed to develop the ten-year strategy needs to engage with all stakeholders. Where possible, the strategy should have their unanimous agreement.
Acting Chairman (Senator Michelle Mulherin): I have to call the Minister of State at 6.40 p.m. I will try to get in as many Members as possible, but I ask them to be brief.
Senator Brian Ó Domhnaill: I congratulate the Minister of State on her appointment to the important health promotion brief, in which she can play a part in reducing the spend on health services, depending on what policy is articulated. We have had a good discussion. The spend on health services from the public purse is approaching €14 billion, with an additional €5 billion provided by VHI and from other private sources, giving a total of almost €20 billion. The health sector has been debated in both Houses and by commentators in the past ten years, in particular, as people are living longer and as demographics change. There is a higher incidence of disease and a need for prevention, treatment and cure. As a result, there is a cost to the Exchequer and private health insurance companies which must be met. The health sector faces major challenges and having a ten-year vision is the correct way to approach them. I believe we need a 20-year vision both in this country and across Europe. We should not stop at a period of ten years but look much further ahead, taking on board new treatments and so on.
A number of issues need to be targeted, one of which is the cost of drugs and patenting arrangements and how that cost can be reduced. Care of the elderly and home help hours provision, in particular, must also be addressed. Demand exceeded supply by 10% at the end of 2015 and the position will not improve this year, given that the number of home help hours has been cut again. The average cost of a home help is €75 per week. The alternative is for the elderly to participate in the fair deal scheme and seek long-term private or public residential care. The average cost of public care is €1,390 per week, while in the private sector the average cost is €893 per week. When these figures are compared with the cost of a home help, it does not make sense. The Department's strategy seems to support increased spending on the fair deal scheme, for which more money has been allocated this year, as well as for the home help service. That is only one example of how resources are not being targeted efficiently and effectively.
The Department and the HSE have spoken a great deal about seeking efficiencies across the sector, but that is not happening. There are no financial oversight or performance-related auditing and accounting practices to achieve value for money and more effective outcomes for the patient. The approach is, therefore, not patient-centred, rather it is about going into hospital and cutting costs. Until the system is changed from providing a block grant for hospitals to one in which the money follows the patient, patient care will not be at the centre. For example, Letterkenny General Hospital should receive a block grant based on performance last year, not this year. It does not make economic sense. I am examining this issue from a financial point of view in allocating resources more efficiently and effectively. Reference was made to the OECD report on spending on the health sector. It found that the spend in Ireland was higher than average but that outcomes here were lower than average. Our ten-year vision must be considered in that context.
There are many other issues to be raised but other Members are offering. I would very much like to have an opportunity to engage in an open-ended debate on health services, with contributors having extended time because every Member has something to offer. Our spokesperson, Senator Keith Swanick, has made the case on primary care services and I agree wholeheartedly with him.
Senator Máire Devine: I wish to share time with Senator Niall Ó Donnghaile.
We could form a multidisciplinary team in this House. We have among us Members who are GPs, mental health advocates, registered nurses, addiction and disability advocates. I ask the Minster to please include us in the membership of the Committee on the Future of Healthcare.
I welcome the Minister of State. Some would commiserate with her on being given what is perceived to be a poisoned chalice, but, unfortunately, the health system has been fatal for patients with whom I have been involved, given the savage cuts made during the years of austerity. I hope we will turn things around and make a great plan for the next generation and the generation after it which will need it most.
I would like to address the issue of inequality. Inequality in health care provision is its most shocking form. The Committee on the Future of Healthcare will convene and draw up a blueprint for the sector. I hope there will be a frank and open discussion in order that we will try to come to a consensus on what is best for this and the next generations. We must realise we will have to pay and that it will cost more. The population is increasing and people are living longer; therefore, our needs will increase. Good health is the basis of every single facet of our lives.
I will push for the introduction of universal health care. We need to look into it, but many countries have it as a right, with health care being free at the point of delivery and based on need alone. I work in the health service which is hanging by a thread which is in danger of wearing away. We are overburdened and the position is chaotic. I will, I hope, bring forward Sinn Féin's vision taken from its health policy document which has been costed and analysed. It will take an additional €3.6 billion to get to where we need to go in order to have universal health care for all.
Is the Minister of State aware of the second annual report from the national health care quality reporting system which was published recently and reported on in The Sunday Business Post? There are significant variations across the State in the survival of patients following a heart attack or a stroke, while the mortality rate in small hospitals is almost 17%, well above the average of 6%. It is across all seven hospitals mentioned in the report. Perhaps the Minister of State might comment on this.
Senator Niall Ó Donnghaile: I am grateful to have the opportunity to address to some of the issues mentioned in the plan. I was wondering, with all of the health care professionals in the Chamber, if one of them could prescribe some antihistamines for me because it is hay fever season and I am struggling. I hope I will get through this debate.
One of my main issues with the Minister's plan is the lack of a reference to cross-Border health care and implementation plans. Border communities suffer disproportionately and as a result of partition face unique and demanding issues, but it is not all doom and gloom, which is why I am surprised there is no reference to the issue in the plan. There have been outstanding cross-Border initiatives, for example, the provision of a cancer treatment ward in Altnagelvin Area Hospital in Derry. Gone are the days when people from County Donegal had to travel to Dublin to receive treatment. They now only have to travel a short distance to Derry. There is the all-Ireland network of heart services which deal with cardiac problems, particularly for children, which has been a positive development. Perhaps, as part of the broader discussion on health services, we might examine the needs of Border communities and how we work with colleagues in the North. I am sure we will have a willing partner in the Northern Ireland Minister, Michelle O'Neill, MLA, in working with us to address some of the critical issues. Based on scientific evidence, she moved recently to lift the MSM ban on the making of blood donations by gay men. The Irish Blood Transfusion Service is currently appealing for donations which tend to drop in the summer months.
Obviously, one of the core issues at the heart of the health service and looking after people in need is the making of critical blood donations. Will the Minister of State, or her colleagues, address the House on what moves could be made to lift the ban in place here?
Acting Chairman (Senator Michelle Mulherin): Unfortunately, in accordance with the order of the House, there is no time left for the other Members who indicated to contribute.
Minister of State at the Department of Health (Deputy Marcella Corcoran Kennedy): I thank those Senators who generously congratulated me on my appointment to my new role as Minister of State with responsibility for public health promotion. As this is my first time in the Twenty-fifth Seanad, I extend my sincere congratulations to every Member. I am looking forward to working positively and constructively with him or her in the years to come. Members will note the optimism in the use of the term, “years to come”. In politics, one needs to be positive and optimistic.
I am pleased to have heard most of the excellent contributions made across the Seanad and the Dáil on the Committee on the Future of Healthcare and the health service. The committee will look carefully at the future of the health care service. I welcome its establishment which was a key commitment in A Programme for a Partnership Government. Universal health care is not just a policy to be implemented or for change for the sake of it, rather it is a direction on a journey towards a better and fairer health service for all citizens. Given the year that is in it, it behoves us to follow through on the ideal of cherishing all of the children of the nation equally and to create a vision for a universal single-tier service in which patients will be treated on the basis of health need rather than ability to pay. While this task is challenging, the committee provides a great opportunity to bring us further along the road towards universal health care.
I have taken note of the questions asked by the last two speakers and will refer them to the Minister for Health, Deputy Simon Harris, for a direct response. I have also noted the comments on the committee being a joint committee in which Senators should have an opportunity to participate. I will ensure the Minister is directly advised of this. The Department will be happy to assist and advise the Houses of the Oireachtas, as appropriate. I look forward to the outcome of the committee’s work and wish it well in its deliberations.
Acting Chairman (Senator Michelle Mulherin): When is it proposed to sit again?
Senator Colm Burke: At 10.30 a.m. tomorrow.
The Seanad adjourned at 6.45 p.m. until 10.30 a.m. on Wednesday, 22 June 2016.
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