I remind people about their phones and time limits.
Ceisteanna ó Cheannairí - Leaders' Questions
D’fhógair an Tánaiste inné go raibh sé i gceist aige deireadh a chur le ceann de na príomhchosaintí a bhaineann le neodracht na tíre seo, sé sin, go mbeadh tacaíocht ag na Fórsaí Cosanta ón UN do na misin a bhfuil siad gníomhach iontu. Déanfaidh sé seo damáiste do neodracht na tíre seo, nó neodracht na hÉireann, agus níl tacaíocht ann ó mhuintir na hÉireann fá choinne seo:
The current policy works and it has complete popular legitimacy. There is no reason whatsoever to change it. Such a change will impress no one in Europe and it will contribute nothing to international peace. Instead of sniping at our neutrality, the Government should acknowledge what we have achieved because of it and set out a policy to strengthen rather than to undermine it.
Those are the Tánaiste's words spoken in response to the then Fine Gael Minister's attempt to adopt a long-term ambition of Fine Gael to undermine Irish neutrality by removing the protection that underpins it, the triple lock. The Tánaiste rightly stated in response:
Fine Gael is arguing that Ireland is failing in its European responsibilities and is allowing Russia and China to have a veto over our peacekeeping activities. This is nothing more than an out-of-touch ideological obsession on the part of Fine Gael which ignores the facts of Ireland’s international standing.
It is clear now that the Tánaiste has now adopted Fine Gael's out-of-touch ideological obsession. He may argue that things have changed and indeed some things have changed. What has changed is the inability of our Defence Forces to carry out the role that gave Ireland the international standing that he once lauded as a result of the failures of Fine Gael and Fianna Fáil in government.
Irish soldiers have been part of a UN peacekeeping mission in the Golan Heights, important work for our Defence Forces, and they have been rightly commended on their bravery and their commitment. Ireland is set to withdraw from that peacekeeping mission not at the behest of Russians or Chinese or any external government, but because of an Irish Government. Today there are just 7,600 members across all services of our Defence Forces, a complete scandal and well below the establishment figure of 9,600 or indeed the target of 11,500. Under the Tánaiste's watch more members of the Defence Forces are leaving each year than are being recruited.
Instead of addressing these problems the Tánaiste wants to abandon decades of Irish foreign policy of military neutrality by abolishing the triple lock, an intention he made clear to the Dáil last night. Not once did he specify the missions he wants Irish troops to participate in and from which they are currently precluded. Maybe he will outline some of those missions in his response. There was no consideration from him as to what this will mean for Ireland's international standing if we were to send troops abroad on military missions that do not have the legitimacy of a UN mandate.
The triple lock is a core protection of Irish neutrality. It is there to address the real and legitimate concerns of the Irish people regarding the drag into an EU military framework. It is not just me saying this; this was the great sell of Fianna Fáil and Fine Gael in advocating for the Lisbon and Nice treaties in separate referendums. Without this guarantee of the triple lock of Irish neutrality protection, it is highly likely that those referendums would not have passed. Therefore, if the Tánaiste is so convinced of undermining Irish neutrality and ending the triple lock, he should do the honourable thing, the democratic thing, and put this fundamental shift of foreign policy, which he announced yesterday and which removes assurances previously given, to the Irish people. He should put it directly to the electorate and let us see if he has a mandate to do what he announced yesterday.
It was the Fianna Fáil Party that introduced military neutrality during the Second World War. The only party in this House that sought to actively undermine the Irish policy of military neutrality during the Second World War was the Sinn Féin Party. That party's leader erected a statue to Seán Russell who collaborated with the German Nazis. That is Sinn Féin's history of its commitment to military neutrality. Those are facts. They erected a statue and honoured the person who actively sought to undermine Eamon de Valera's policy of military neutrality. I take no lectures from the Deputy in respect of our commitment to military neutrality.
What Sinn Féin has classically done here now again and what it does all the time in the realm of foreign policy is to create strawmen all over the place, create false premises, dishonest debate and active disinformation. The Deputy starts his presentation by saying we are out to undermine Irish military neutrality.
Those were your words.
We are not in any shape or form-----
I was quoting you. Those words were your words.
I did not interrupt the Deputy, please allow me the courtesy of responding to his points.
I was just quoting you back.
Deputy Doherty is helping you.
I cannot claim credit for them.
Tánaiste, we will hold the clock for a minute.
I cannot claim credit for your words.
Deputy, I am holding the clock to allow for order to resume. Please allow the Tánaiste to speak uninterrupted.
There is no proposal and there will be no legislative proposal to come before this House to undermine our policy of military neutrality. We have made that crystal clear. We are not members of a military alliance. We are not joining NATO. There is no proposal to join NATO as the Deputy knows well because he slipped in his remarks that we want to participate in a European - I think he said - military framework. That is what he just said.
I did not say that either.
It is more dishonesty because, of course, we know Article 29.4.9° of the Constitution, which we put in in 2002 and reaffirmed in 2009, states: "The State shall not adopt a decision taken by the European Council to establish a common defence pursuant to Article 42 of the Treaty on European Union where that common defence would include the State." Therefore, we cannot, without a constitutional referendum, participate in any EU common defence pact. The Deputy should not set out false stories here.
I did not say that.
The triple lock does not critically underpin our policy of military neutrality. It is essentially about the deployment of troops overseas. Why do we want to change it? Why do I want to amend it? It is because I do not believe that Russia, China or the United Kingdom or for that matter the United States or France should dictate Irish foreign policy or should dictate when we do or do not deploy troops.
You are the one removing our troops from UN missions.
The world has changed fundamentally. The UN Security Council could not even issue a statement on the invasion of Ukraine. We all know about the late Yevgeny Prigozhin and the Wagner group. Russia is more interested now in deploying the Wagner group to parts of the Sahel or other parts of the globe instead of any UN peacekeepers. That is the reality of where we are today. However, of course, Sinn Féin has had a history of being soft on Russia down through the years.
All deleted now.
It supported Russia when it invaded Crimea in 2014. I was in this House and Sinn Féin's silence was clear to all. In fact, it sent people to international conferences supporting Russia's invasion of Crimea and going along with the Russian propaganda that there were neo-Nazis in Ukraine. The Deputy did that. That was Sinn Féin's position in 2014 and it got away with it.
That is not true.
Sinn Féin could not get away with it in the current crisis in terms of the war. Its whole foreign policy has been one of incoherence and incompetence. Ní aontaím leis an Teachta. Tá sé mícheart. Níl aon deacracht in aon chor ó thaobh an pholasaí atá againn ó thaobh neodracht mhíleata. Ní bheidh aon athrú ann. Caithfidh mé é sin a chur os comhair an Teachta.
It is desperate stuff from the Tánaiste. I know it is difficult to hear his own words back when Fine Gael tried to do exactly what he is doing and he talked about this ideological nonsense. He talked about undermining Irish neutrality: "Fianna Fáil reaffirms its commitment to the retention of the Triple Lock... prior to committing Defence Forces personnel on overseas service." Those are the words of the Fianna Fáil 2020 general election manifesto, now gone with the wind. "The Government will ensure that all overseas operations will be conducted in line with our position of military neutrality and will be subject to a triple lock of UN, Government and Dáil Éireann approval." That is from the programme for Government agreed between Fianna Fáil, the Green Party and Fine Gael. "[T]here is presently no appetite for a change to the current position on Irish neutrality". That is from the report of the chair of the consultative forum that the Tánaiste hoped would provide a preordained move to fundamentally change a foreign policy that has served Ireland well.
The Tánaiste has no mandate from this. He can scratch the bottom the barrel all he wants. I am talking about the future. I am talking about the missions that do not have a UN mandate to which he wants to deploy Irish troops. I am saying to him that he does not have a mandate for that. He never campaigned for that. The programme for Government did not state that. If the Tánaiste is secure in his position, he should put it to the people in a referendum and let them decide whether they want to undermine our neutrality or not.
There was absolutely no policy to undermine our military neutrality. The Deputy should stop deliberately creating a false story. The bottom line is this. The Deputy seems to have a view that Russia should dictate our foreign policy.
No, I do not.
You are. That is exactly what you are saying. We know the-----
(Interruptions).
What mission?
What mission?
Through the Chair, I think-----
Tánaiste, sush please. Can we do this through the Chair, please? Can we listen please?
A Leas-Cheann Comhairle, when you say, "can we do it through the Chair", I have been doing it consistently through the Chair.
We are asking a question.
I have been interrupted repeatedly by Deputy Doherty------
(Interruptions).
-----and this has happened every week now. This is happening every week.
Tánaiste, the clock is now running again.
Suing journalists, shouting down the Members of Parliament.
Who is interrupting now?
Deputy, please.
Welcome to the Sinn Féin world.
Minister.
Suing journalists.
The core values of Fianna Fáil are coming out.
I believe-----
(Interruptions).
That is it.
I want to make the point-----
No, sorry. We are not going to have this sniping across the floor. I will resume my seat and we will listen to the Tánaiste uninterrupted.
I believe there is something morally wrong with the fact that an authoritarian and aggressive neo-imperialist power has a de facto veto on elements of how we as an independent Republic react to any given situation. That is the fundamental truth of where we are today. They invaded Ukraine, they violated the UN Charter and the Deputy is saying that they should have a veto over how, when and where we deploy our troops.
That is not what we are saying.
That is the essence of the Sinn Féin policy, which I reject and oppose. Finally-----
Which mission do you want to move on without a UN mandate?
-----anything we do-----
You cannot even give an example.
Deputy, please. Tánaiste, tá muid thar ama.
Give us one example.
Anything we do-----
Why will you not answer the question?
Tánaiste, tá muid thar ama.
Anything we do will be utterly consistent with the UN Charter and the upholding of UN fundamental rights.
Which mission in the last five years would you like to deploy using Irish troops without a UN mandate?
Sin é.
The prospect of a temporary end to Israel’s brutal bombardment of Gaza and the expected and hoped-for release by Hamas of women and children hostages including, we hope, Emily Hand, offers a glimmer of hope in what are very dark days. However, we all appreciate that work must continue and diplomatic efforts internationally must intensify until a permanent ceasefire can be agreed. We have heard from the Israeli Government that it has two stated aims, namely, the release of all hostages and the elimination of Hamas.
While hope remains that a pause will last until we see hostages released, we know that tragically Netanyahu’s approach to that second stated goal has involved the merciless killing of so many children, women, men, doctors, UN staff, journalists and others. We must not be naive about the enormous challenge of protecting what remains of Gaza and preventing what looks hideously increasingly likely to be the genocide of its civilians.
For our part, I think we can all agree that Ireland has the benefit of our diplomatic reputation and the respect of countries internationally. That position morally obliges us to act to challenge in the strongest possible terms the horror that has been unleashed by the Israeli Government and to seek to end the bombardment of the people of Gaza. We have heard workers from the United Nations and Médecins Sans Frontières saying that this is the worst situation they have witnessed in their careers. Gaza is now the most dangerous place in the world for a child and the average age of a person killed in the conflict is just five years old. It is heart-breaking to think of those five-year-olds.
We need to act. We need to deploy tactics, such as those that were used against South Africa during apartheid, to put an end to the brutality of the Israeli regime. We need to act to impose strong sanctions on Israel and end trade with the occupied territories. While we may be militarily neutral, we are not politically neutral in the face of the brutal bombardment of Gaza. We have yet to use all the diplomatic tools that are available to us in the Gaza context. That makes even more frustrating yesterday’s surprise announcement by the Tánaiste about the triple lock, which does have a link with our neutrality. We cannot separate the two.
Despite the Tánaiste’s denials when the Consultative Forum on International Security Policy was formed, it is clear that his announcement in the wake of that represents a creeping drift in the Government away from our longstanding policy of military neutrality. In the Dáil, the Tánaiste effectively asserted last night, and indeed again today, that the triple lock leaves us at the whim of five countries and in particular at the whim of Russia on the UN Security Council.
I share the Tánaiste’s views on Russia. I absolutely share them. I have no time for the Russian regime. Yet, it is the answer to the wrong question to say that we should move away from the triple lock because there is a problem with Russia’s veto on the UN Security Council. The question we should be asking is the question of reform of the Security Council to remove that veto and move away from the power the UN Security Council has. The reality is that our triple lock in the Defence Act provides that we may participate in international peace-keeping forces that are mandated by the UN General Assembly, as well as the UN Security Council. We need to see the power of the UN General Assembly being asserted and brought to the fore in the United Nations.
If I may, I think the Tánaiste is putting the cart before the horse in seeking to change a longstanding policy that is represented and protected by the triple lock. We are asking him to abandon plans to end the triple lock and instead to enshrine Ireland’s neutrality in the Constitution.
Thank you Deputy. We are way over time.
We must use all the diplomatic tools at our disposal to bring about a ceasefire in Gaza.
The Deputy has raised two issues, the first of which is the Middle East and the current situation there. I agree with everything the Deputy has articulated in respect of the appalling killing of children, innocent civilians and humanitarian aid workers whose work is extraordinarily brave and courageous. It is outrageous that the UN humanitarian workers are being killed, as it is in respect of medical care workers and journalists who are reporting bravely on the situation in the Middle East.
We welcome what we are hearing about the truce, albeit a short one, in respect of getting the hostages out. We pray and hope that Emily Hand will be one of those hostages and indeed that all the children who are hostages are released. There is no moral justification for hostage-taking at all. That needs to be called out. We want to build on that truce to create a permanent cessation of violence. I will be attending the Mediterranean ministerial meeting between Arab countries and EU ministers on Monday. We will be working with other like-minded EU states to build on the truce and create approaches to a road map to peace from the appalling war and loss of life that is currently under way and to chart a way incrementally and develop confidence-building measures to ensure that peace comes to the Middle East. It has to be on the basis of a two-state solution, but we need to create a road map for that where there will be two states in which people can co-exist in harmony and peace. That has to be driven internationally and it has to be done strongly. Israel in particular must stop the aggression towards settlers in the West Bank and the violence there. Yes, we must pursue that with sanctions if it continues. It must also link the West Bank to Gaza and the Palestinian authority to oversee that. These are the issues we have to work on.
In respect of the triple lock, I have received no answer. The consultative forum was a very good forum, despite the attempts by Sinn Féin and others to undermine it. They did not even want to give it a chance, which I find shocking.
I was at it every single day, but you were not.
I found it shocking that people did not even want to give a debate a chance. They attacked the chairperson. They sought to undermine it. Then, when they went to it-----
Who did?
You did.
I did not.
Then, when people went to it-----
Resume your seat, Deputy Carthy.
I want that to be corrected. I did not attack the chairperson of the consultative forum.
Deputy Carthy, resume your seat.
The record shows that and I want that to be corrected and I want that to be corrected immediately.
That is a serious challenge.
Are you going to sue him?
Sue him Matt. You sue all the journalists for saying that.
Excuse me-----
In any event, it was-----
Excuse me, I am making a legitimate point of clarification. The Tánaiste is after accusing me of attacking somebody who I did not attack.
Tánaiste, please.
Deputy, you did-----
Deputy Carthy you are out of order.
I want that to be clarified and corrected on the Dáil record.
Hear, hear.
Deputy Matt Carthy you are out of order.
I am suggesting-----
You are out of order. I am ruling that you are out of order.
I am suggesting that the Tánaiste is very much out of order.
Resume your seat.
Could I say to Deputy Bacik, in terms of the triple lock-----
Tánaiste, please. We are not proceeding like this. We are not proceeding like this. The time is now up. I ask for co-operation in relation to this and for a little respect for Leaders’ Questions.
Through the Chair, in respect of the triple lock, the consultative forum was a very rational, reasonable, very well-balanced debate. That is important. There was clear consensus about supporting military neutrality. There is no question about that. In the context of the triple lock, there has not been a peacekeeping mission sanctioned by the UN since 2014.
Tánaiste, time is up.
I just happen to believe-----
We are way over time.
-----that we cannot allow Russia, China and everybody else to dictate what we do.
The Tánaiste’s comments on sanctions are welcome and I hope we will hear more about that. He is right to commend the UN aid workers and the UN role in Gaza. But it is undermining of the UN to suggest that because of flaws in the UN that we should somehow abandon our triple lock. That was not the recommendation that was made by Professor Richardson or her forum. She acknowledged the matter was contested and her report had other recommendations that are vitally important, including more spending on the Defence Forces.
Senator Wall raised this in the Seanad yesterday, calling for urgency in implementing recommendations of the Commission on the Defence Forces such as access to the working time directive. Deputy Howlin reminded us that in the budget the increasing defence spending has soared to the dizzying heights of just 1% of GDP. We need to do much more to support our personnel in the Defence Forces and ensure they are well-equipped to engage in UN-mandated peacekeeping missions. It is entirely ill-conceived to start talking about dismantling or undermining the triple lock or undermining and critiquing the role of the United Nations, which, however flawed, is a global forum and agency for peace that was established after the carnage of the Second World War. We have a proud role and history in Ireland with the United Nations. It is wrong to talk about dismantling the triple lock and removing that requirement for a UN mandate just because most of us have an issue with Russia.
I was 12 years of age in 1972, when the referendum on joining the European community took place. Parties across here opposed it at the time. There were groups, which are still at it today, arguing that if we joined what is now the European Union, we would have NATO troops and nuclear warheads parading down O'Connell Street within a few weeks. This is what was said as far back as 1972 and I have heard the same mantra throughout the debates on all the European treaties since then, which people have opposed, and it never happened. We put a provision into the Constitution which prohibits us from joining a European Union common defence pact, yet we are happy to go along with Russia and the Wagner Group replacing UN missions in areas-----
We are not.
Because of their geopolitical ambition and agenda, they do not want peacekeeping missions around the world any more. We know where the world is today. It took six weeks-----
What is the alternative?
The alternative is we stay consistent to fundamental human rights and the UN Charter. The UN Charter mentions regional actors; the EU or the African Union are bona fide actors. We should not just react-----
It is imperfect but what is the alternative?
-----in a knee-jerk way to what I proposed yesterday in terms of amendments. We should have reasonable debate but there seems to be an inability in this House to have a reasonable debate about these matters and false hares get sent up the field.
Deputy Bacik, resume your seat.
Thank you because I was not part of the pathetic shouting earlier.
I excuse you from that.
The childish petulance.
If the Deputies want to change the rules on Leader's Questions, they should do so at the Business Committee or the reform committee. It is not interactive. Those are the rules so we will stick to the rules until the body changes the rules. In the meantime, I am moving on to the next question from the Regional Group and an Teachta Berry.
I want to raise a matter of national significance and importance. It has a pensions component as well a national security component. I refer to the impending retirement of the deputy Garda commissioner for policing and security, who will most likely retire in March or April next year. Unfortunately, not a single serving member of An Garda Síochána has applied for promotion to replace her because if they do, they will get hammered from a pensions point of view. Revenue will nail them and there is no financial incentive to apply for this promotion. On the contrary, there is a financial disincentive to apply.
I agree with the standard fund threshold, SFT, which is important. It was introduced in 2014 for banker's pay. Unfortunately, this one-size-fits-all pension threshold has had unintended consequences and it disproportionately affecting An Garda Síochána in particular because of its fast-accrual pensions. When people are in the senior echelons of An Garda Síochána and at the peak of their powers, they do not apply for high office because they are financially disincentivised from doing so. Some of these gardaí, if they apply for this job, will be hit with up to €200,000 of a tax bill on the day they retire. A massive tax bill is, therefore, pending if they apply for this job and get it, and that is the reason not a single one of them has done so.
It is a big issue from a workforce planning point of view but perhaps even more important from a the national security point of view. As the Tánaiste will be aware, An Garda Síochána is unique. It has a policing function as well a national intelligence function. It is important that the person who applies for or is given this job is an Irish citizen, just like an Irish diplomat must be an Irish citizen. Unfortunately, there have been only a small number of applicants and they are all from outside this jurisdiction. That is not the way to do business because if you are applying for the position of head of Irish intelligence, the assumption is that you have worked in the intelligence services and apparatus of other countries, and that would give other countries a strategic advantage over this jurisdiction. That is not the way to do business.
Does the Tánaiste accept that there is a problem and an anomaly here? Does he accept that it is something that should be fixed? How does he propose to address it in the short to medium term?
There are two issues. The first is the financial issue and the second is the security and intelligence service. The Deputy is suggesting it should be an Irish citizen who takes the job, which I will come back to. I understand the concerns he has articulated about the fast-accrual pension scheme, which applies to An Garda Síochána, and the limit on pension funds, which has been discussed in this context as the standard fund threshold, which sets a lifetime maximum for tax relief on pension contributions. That is part of a tax system which generally applies for everybody and for all pension products or schemes, both in the public and private sectors.
The Minister for Finance has indicated that an examination of the calibration of the SFT will be undertaken and that a memorandum for information on this examination is expected to go to Government shortly. That targeted examination will require input from a range of stakeholders, including the Department of Public Expenditure, National Development Plan Delivery and Reform and other Departments. The difficulty is that the examination is expected to conclude by summer 2024. There will be a public consultation and any outcome of that will apply to both the public and private sectors. As the Deputy knows, the standard fund threshold sets a limit for the total amount of contributions into an individual's pension and then, when it is crystallised, the pension benefit value is assessed. The value, for the purposes of SFT, depends on the annual pension benefit payable and the age at which benefits are earned. Where the value is higher than the SFT, the excess is subject to additional tax, on top of the normal taxes at the marginal rate. There are clearly issues here and, in parallel with that, there are issues in the security and intelligence services.
We need to be cautious about making declaratory statements as to citizenship. Any external candidate considered for appointment by Government must generally be subject to security clearance and they are notified of this in advance. Any person who is appointed to An Garda Síochána is required to attest as a member and make a solemn declaration to uphold the Constitution and the laws of the State under section 16 of the Garda Síochána Act. Ultimately, the appointments to the office of deputy commissioner are made by the Government on the recommendations of the Policing Authority. It is a matter for the Garda Commissioner to determine the role and responsibilities of any particular officeholder. There is manoeuvrability and the Garda Commissioner can take on board security and intelligence issues in apportioning or allocating responsibilities to any given member of the leadership team. There is a financial issue, which the Deputy has identified. He is correct in outlining why it was brought in originally and, nonetheless, it merits examination.
I thank the Tánaiste for that useful response. It appears that there is at least an acknowledgement that there is a problem and that the problem can be addressed. My concern is that if it is not addressed until next summer, there will probably be a gap in that appointment while the deputy commissioner retires. I want to flag this and it is important that this post is filled. There is a reason not a single member of An Garda Síochána has applied for the role. That reason, as the Tánaiste pointed out, is financial, and, hopefully, that can be addressed in the short term.
It applies to all aspects of the public and private sector, but particularly to the public service at a given stage, especially where there are fast-accrual pension systems. I will revert to the Ministers for Finance and Justice on the issues.
I want to revert to an issue I have raised with the Tánaiste on a number of occasions, namely overcrowding in the accident and emergency department of University Hospital Limerick, UHL.
This morning, there are 90 people on trolleys in UHL. That is a good day now. It would have been unthinkable a number of years ago but there are 90 people on trolleys this morning. Almost one quarter of all those on trolleys in the country are in UHL. The Tánaiste is or claims to be a republican. Almost everybody in this House claims to be a republican. One of the key aspects of republicanism is equality. There is a disparity in healthcare across this country. People's experience of UHL is generally quite good other than the accident and emergency department, where the experience is almost universally negative. That is unfortunate because it the only encounter many people have with the hospital.
Why does that disparity continue to exist? I see the Minister, Deputy Donnelly, in the Chamber. When I raised the matter with him he told me there had been 2,000 new posts since this Government came into office. When I asked UHL for a breakdown of those posts, I found out the actual figure is only two thirds of that figure. I welcome the fact that there are over 1,300 new posts. It is not quite as good as what the Minister is claiming but it is a big improvement. Nevertheless, the disparity continues. UHL management indicated it has 13% fewer staff than other comparable model 4 hospitals and the population it has to deal with is 13% higher and it has fewer staff. It also pointed out that the number of people over the age of 70 in its catchment area is 20% higher, which places additional requirements on the hospital. What will be done in this Republic under this republican Government to bring about an equality of healthcare across this State?
The people I represent are not second-class citizens. They are not first-class citizens either. There are no first and second classes in this State. There is a disparity, however. I have been to accident and emergency departments with family members in Dublin and also in Limerick. There is a massive disparity in treatment. It is huge. I do not think some members of my family are first-class citizens and some are second-class citizens. This is unacceptable and it is very much concentrated in the mid-west. I want to know what the Government and the Minister of Health, who the Tánaiste appointed when he was Taoiseach, and who is still the Minister for Health, will do. I argued at the time that the Minister of Health should bring this matter to the Taoiseach's office to have it sorted out but he did not do so. It may be beyond any Minister for Health to sort it out but it needs to be sorted out because the accident and emergency department in Limerick is unfit for purpose.
It is my understanding that University Hospital Limerick has the largest capital investment programme at the moment in terms of new projects that are in the pipeline. The Minister has indicated that to me. Much of that has to happen. As the Deputy knows, work on the new €90 million project, consisting of a 96-bed inpatient block and renal dialysis unit, commenced in October 2022. The Government also committed to the delivery of a second 96-bed inpatient block at University Hospital Limerick. That will make a difference. An additional 150 beds have been opened in the UL Hospitals Group since 1 January 2020, 98 of which are in UHL itself. The €2 million purpose-built injury unit at Ennis hospital opened in April 2022. The number of whole-time equivalent staff has gone up to well over 1,000. The budget in 2022 was 19% higher than in 2019. A new geriatric emergency medicine unit was opened, with a focus on preventing emergency department attendance and admissions for those aged over 75. New plans were announced to make UHL one of the five regional scheduled care hubs. There has also been work in Croom orthopaedic hospital to take pressure off theatres, wards and clinical areas.
In respect of accident and emergency departments generally, it is my view that there needs to be a focus not just on resource allocation but also on the organisation of emergency medicine in the country. That has to happen at hospital level and there has to be whole-of-hospital involvement in emergency medicine, with all the departments and disciplines, if you like, working to take over cases within emergency departments and, likewise, within the HSE itself. Very often, the emergency department becomes the focal point of public outcry and anger because, as the Deputy said, for many people, it is the first port of call in respect of their experience of hospitals. We have developed many alternative care pathways, from first responders through to primary care, enhanced community care and medical assessment units. Ultimately, in all care, the sooner we get the patient to the person who can meaningfully treat that patient with the requisite qualifications, the better. It is my view that, to a certain extent, and this has been going on for a number of years, the unrelenting focus on accident and emergency departments sometimes misses the point of the broader hospital environment and the broader reform agenda that is required.
I thank the Tánaiste for his engagement, which is greatly appreciated. He is right that there are many projects under way in Limerick. There are also other projects under way across the State. In St. Vincent's University Hospital, for example, instead of having elderly people coming into the hospital, the hospital is sending out teams. I wonder whether something like that could be considered for UHL given the age cohort of the population of the mid-west. It certainly seems to be a success in St. Vincent's University Hospital and it could well help many people in the mid-west.
The Tánaiste spoke about a whole-of-hospital response, and I agree with him, but beyond that, there has to be a whole-of-hospital-group response. Since I came into this Dáil in 2020, I have called for a greater utilisation of Ennis, Nenagh and St. John's hospitals. The reality is that if a young man or woman, and it is mainly young men and women who play sport, has an injury while training at nighttime, he or she will end up in UHL because the local injuries unit stops operating at 8 p.m. I proposed in a motion in this Dáil that these units open 24-7. Moving towards that, even if they were open until 10 o'clock at night, it would bring many benefits and alleviate a lot of pressure on the emergency department in UHL.
I do not disagree with the Deputy in terms of alternatives. Sporting injuries, unless they are very serious, should not automatically end up in the emergency department of UHL.
It does not work.
in County Cork, the Gurranabraher centre injury unit has become a phenomenal service.
It is a long way from Kilmeedy to Gurranabraher.
I know, but there are injury units in the mid-west and they are going to be expanded. The Deputy is right. To me, that is elementary and should be pursued. There is also the alternative pre-hospital pathway that has been developed since September of this year between the UL Hospitals Group and the National Ambulance Service, which will see definitive care provided in the community to patients who call 999 or 112 and reduce the numbers of ambulances bringing patients directly to the emergency department. That involves specialist emergency medicine doctors and National Ambulance Service personnel responding to low acuity ambulance calls. Again, that is from 10 a.m. to 6 p.m. We have to work to extend the time. It is, however, a very good service and idea. The medical assessment unity pathway is for 112 and 999 patients in Ennis and Nenagh hospitals. That has now been extended to St. John's Hospital. Generally speaking, I agree with the thrust of the Deputy's argument. Much of that work is under way.