I will not start to speak until the Minister for Finance has taken his seat.
Leaders’ Questions.
He has a safe seat.
Members may not realise that today is the third anniversary of the re-election of the Government. It is obvious that the Government was re-elected on the basis of clear and specific promises, some of which I will mention. Although it promised to end hospital waiting lists within two years, the most recently published figures indicate that approximately 27,000 people are on waiting lists. It promised to reduce the rate of inflation, but Ireland is one of the most expensive countries in Europe. The Government, which has belatedly realised that it has been fostering this country's rip-off culture, will make an announcement in that regard on Wednesday. It promised an improvement in facilities in accident and emergency departments, but the crisis in that regard has worsened to the extent that 368 people were on trolleys in our hospitals in a single day. The Minister for Justice, Equality and Law Reform promised 2,000 extra gardaí——
They are coming.
——but just 80 have been delivered in each of the past three years.
They are coming, just like Christmas.
The Government promised to keep taxes down, but instead it has delivered 34 new stealth taxes. I could refer to the failure to deliver a new terminal at Dublin Airport, to complete the introduction of the penalty points system for road traffic offences and to deal with the issue of class sizes.
As the Minister with responsibility for this country's purse strings, does the Minister for Finance accept that the Government's record comprises a series of missed chances of enormous proportions? This tired and jaded Government shoves the same old problems aside because it is unable to deal with them. Does the Minister, Deputy Cowen, not accept some responsibility for the overrun of €4 billion in the cost of transport infrastructure? Although overspending on medical cards has doubled, 61,000 fewer people are in receipt of medical card cover. After eight years in power, three of which have been since the last general election, does the Minister agree that the matters I have mentioned constitute a sad indictment of a Government that has lost its way? Some members of the Government have become arrogant and distant from the electorate. They are looking forward to a long rest in opposition, after the people give their verdict at the next general election, because they are tired and jaded.
It is obvious that the third anniversary of the Government's election has upset greatly the Leader of the Opposition. Based on what the House has heard from Deputy Kenny, it seems that he has a dull view of the world. I do not agree that the investments being made by the Government are not required. I do not accept what he had to say in regard to the state of the economy and country. In a whole range of areas, we are experiencing real improvements. The Deputy referred to transport. There was no public investment in railways or anything else by the outgoing Government before the Fianna Fáil-PD Government took office in 1997. In fact, a railway safety programme was necessary before we could have a railway development programme because the railways had been left in an unsafe condition.
Last weekend I attended a European Union meeting. The EU unemployment rate is averaging 9% and the estimated growth in the European economy is approximately 2% for this year. In the same period, the Irish economy is expected to grow by 5% while unemployment remains at 4.5%. That is better testimony to the management of the economy than the other issues raised. I remind the Deputy that the programme for Government is for a five year period. I have not heard of a Government which was able to complete a five year programme in three years. We intend to complete the programme in a five year period.
It is typical of the responses of Ministers of this Government that they do not accept responsibility for what is happening. I did not disagree with the Minister that these measures were not required; they are required. However, the Minister is in charge of the purse strings. The Comptroller and Auditor General's recent report stated that transport schemes have overrun by €4 billion yet nobody accepts responsibility for this. This happens right along the line. The Minister for Justice, Equality and Law Reform promised 2,000 extra gardaí.
They are still coming.
The former Minister for Transport, Deputy Brennan, repeatedly talked about speed cameras, Dublin Airport and various reports. The Minister for Transport, Deputy Cullen, was left with the business of €60 million for electronic voting, which was apparently passed by his predecessor as Minister for the Environment, Heritage and Local Government with no accountability. The absent former Minister for Health and Children, Deputy Martin, refuses to accept any responsibility for a €2 billion charge——
Or for anything else.
——on the public purse arising from his refusal to live up to his ministerial responsibilities or to consider what his brief was when the Secretary General of the Department told him on the steps of the Gresham Hotel, or otherwise, that he should have followed the matter through.
Everybody accepts that we have a strong economy, created on the backs of the workers of Ireland and the multinational firms that built the Celtic tiger. However, with regard to value for money, reform of public services and the fact that the health service employs 30,000 people but only 5,000 of these work in the front line, there is appalling waste and misuse of public funds. The Minister for Finance has failed in his central duty to give value for the people's money — a bang for their buck — and the Government has failed to be one of competency and professionalism, or to deliver major projects on time and on budget.
There is no point stating that the Opposition has a dim view of the world — we do not. We accept that these projects are required but they are not required at exorbitant expense to the taxpayer. The Minister for Finance is charged with the responsibility for financial allocations. As a corporate unit, the Government has failed miserably.
I do not agree, for obvious reasons. To compare the final cost of projects with the costs estimated before the project concepts went to the planning stage is a ridiculous and objectionable line of argument. The Comptroller and Auditor General's report concluded that real project cost overruns due to underestimation was less than 20%, in line with quoted international trends. That was the Comptroller and Auditor General's basic point.
That is not true.
I am sorry, but it is true.
It is not true. I was there, so I know.
Deputy Rabbitte, you are not in order.
Deputy Rabbitte knows it all. That is the problem with him.
The Minister does not know very much.
Order, please. The question is in Deputy Kenny's name.
It is about time the Minister demonstrated a bit of knowledge about his job. He should not distort the figures.
I am not distorting the figures.
Yes, you are.
The Minister without interruption, please.
Deputy Rabbitte is the best distorter of figures in the business. When Deputy Rabbitte hears something he does not like, he makes us all out to be cretins and clowns. That is his name-calling. It is the way he carries on.
The Minister is misrepresenting the Comptroller and Auditor General's report.
He might do it with others but he will not do it with me. It is the old game with him the whole time.
The Minister should not try his pugnacious nonsense on me.
I reiterate that the Comptroller and Auditor General's report concluded that real project cost overruns due to underestimation was less than 20%, in line with quoted international trends. We will point out in the debate which will begin later today the steps the Government is taking to deal with those issues as a policy matter. I make the point to Deputy Kenny that we have been engaged in a modernisation programme in a whole range of areas, including education, health and otherwise, which will be outlined in the debate today and tomorrow. That debate will provide an opportunity for Members to put their case on the public record, hopefully without being subject to the name-calling that has already started.
The Minister will understand why the subject of cancer care services is topical. He will know that there was a protest outside the Dáil last week, organised by various community organisations and cancer sufferers from the south east. Why is there interminable drift of the cancer care strategy? Why did the previous Minister for Health and Children, Deputy Martin, promise the extension nationwide of BreastCheck screening for 2002 initially, and, latterly, for 2005? Neither date has been met. Thirteen counties in the west, the north west and the south continue to have no BreastCheck facility, despite the promises of Deputy Martin. It took Deputy Martin two years to finally publish the Hollywood report on radiotherapy services in 2003. He then commissioned another report, involving international experts, to resolve the issue of radiotherapy services in Dublin. That report was received in January but it still has not been published. Those who are in need of radiotherapy had to come to Dublin last week to protest outside the Dáil. Suitable transport facilities in the absence of local radiotherapy services have not been provided. The Minister for Transport, Deputy Cullen, will know about the long-standing campaign in the south east, yet there is no response to that.
Why is it that nobody in Government seems able to make a decision on this issue, as with many other issues, as Deputy Kenny noted? Being pugnacious in the misrepresentation of statistics does not change the written word contained in the assessment of the Comptroller and Auditor General. When will the BreastCheck screening facility be extended nationwide? Those campaigning believe that 65 women unnecessarily die every year because of the absence of this facility, given the critical importance of early detection. When will the report taken in January be published? When will facilities for radiotherapy be put in place? Does the Minister have a specific response to the people who travelled from the south-eastern counties last week to protest outside the Dáil?
The detail on some of these policy points is best addressed by the Tánaiste and Minister for Health and Children. However, I will make the following points. No Government, including this Government, seeks to unnecessarily put lives at risk. Deputy Rabbitte was in Government. Since he left office in 1997, some €550 million has been invested in cancer care. That does not suggest to him that he was unmindful of the needs of people with cancer or the need to develop cancer care services throughout the country. That line of argument does not get anyone anywhere. The context in which the Government is seeking to deal with the issue of cancer care arises from the cancer care strategy framework initiated under Deputy Noonan when he was the Minister responsible. More than €500 million has been invested in cancer care since we came to office. Some 92 additional consultant posts have been created and a further 245 clinical nurse specialists have been appointed. Approximately €95 million of capital funding has been allocated specifically for the development of cancer care related initiatives resulting in major investments, including €60 million in radiation oncology, €8.75 million in the bone marrow unit at St. James's Hospital and €12 million in BreastCheck.
The Tánaiste will give details on the nationwide roll-out of the BreastCheck service in due course. However, more than €60 million has been made available for the development of symptomatic services throughout the country. The 2000 report on the development of services for symptomatic breast disease services recommended the establishment of 14 specialist breast units nationwide. Six of these are fully operational and the remainder are at advanced stages of development. The expansion of the BreastCheck programme to the south east and the national expansion were announced in 2003. Screening commenced in Wexford in March 2004 and in Carlow in April of this year, and will commence in County Kilkenny next year. Approval has been given to BreastCheck to advertise for the appointment of a design team to work on detailed plans for the design and construction of two clinical units in Cork and Galway.
Will this happen in 2007?
The development of cancer care services has not been put on the long finger. It is not true to say that no decisions have been taken.
(Interruptions).
We need to ascertain the way in which we can accelerate the nationwide provision of the BreastCheck service. The Tánaiste has been addressing the matter and has discussed it with me. I leave it to her to decide the way in which she can bring further information to the House.
The stock and trade response to such questions by the Minister for Finance and the Taoiseach is to reel off a number of statistics and refer to when the Opposition was last in office. Patients in pain and in need of morphine and, in some cases, travelling to Dublin from parts of Donegal or Waterford are not interested in the Government playing games with regard to what was in place when I was last in office. I asked when BreastCheck is to go nationwide as announced by the then Minister, Deputy Martin. It was initially announced for 2002, then for 2005. With regard to the southern region, the announcement has been made five times and yesterday the person responsible said that it cannot be put in place before 2008. On behalf of the people for whom this is a cause of acute distress and not political bickering, when will the service be rolled out nationwide as committed to by the Minister for Health and Children? When will the difficulties with regard to location in Dublin and the eastern region be resolved? A report was compiled on the matter in January but no decision has yet been made. Is there any attempt to provide the type of specialised transport that is required for those who must travel long distances from Waterford and other parts of the country while in pain?
This is a policy of drift. I do not know whether the figures listed by the Minister for Finance have been put in place. However, the people in need of these services cannot access them and in many cases it is a matter of life and death. I listened to the people who travelled to protest outside the Houses of the Oireachtas and the services are not in place. That is the issue for them. With regard to the tax incentivised private unit in Waterford, I have no idea about the arrangements which have been entered into with consultants or how it will care for public patients. These are very important and painful issues for many families and early detection is essential. There has been no investment in cervical screen testing.
I assure Deputy Rabbitte and the House that I am not involved in bickering or playing games with the issue of health. I did not suggest that I was unmoved by the prospect of 85 people at risk of dying or that I was unmindful or disinterested in the fact or that the Government was callous. There is not a policy of drift but a very proactive investment programme in place. It has not yet fully developed the services as we would like, but no one has a monopoly on sympathy or virtue with regard to the matter. I have not introduced any bickering or game-playing. Indeed, a political game is being played regarding the suggestion that there is a policy of drift in terms of what this Government does in economic or social terms. An attempt is perhaps being made by the Opposition to suggest that all this money is a waste of time and resources and has no beneficial effect. However, it does. The appointment of 92 consultant posts since 1997 is not a statistic and represents a level of expertise in the health service that was not available heretofore. It is in place to assist the many families, individuals and communities throughout the country who suffer from this disease which causes such anxiety. That is the point I was making. I am not attempting to score points but to defend the Government's record, which is my legitimate right.
With regard to the south-eastern region, the Government is doing all it can to see how we can develop radiotherapy services nationwide. When I was Minister for Health and Children, it was suggested that there would be two radiotherapy centres in Dublin and one in Cork. I reviewed the situation and provided objective criteria to confirm why the location of a radiotherapy service in Galway University Hospital would be justified. It did not depend on economic considerations but the medical throughput required for the provision of such services in that a certain level of population was needed for the service to be provided. That was the thinking at the time and the service was provided by the Government. That radiotherapy service is now in situ in Galway and has recently commenced.
The search for a solution to the problem of the provision of outreach services beyond the satellite services in Dublin, Cork and Galway has taken up the time and effort of those in the Department of Health and Children as well as the former and present Ministers. I am acutely mindful of the problems encountered by those who must travel to Dublin for specialist services. The midland health board region is the only one in the country that does not have renal services. Everybody from my constituency and bordering constituencies has had to travel for such services. I am aware of the issues and progress is being made.
Not all problems have been solved and we will continue to address them. The Tánaiste has my support and that of her Government colleagues in finding solutions to the problem. It has been suggested that a private hospital in Waterford would be able to provide such services and we would be anxious that they be provided to the wider public regardless of their means. That is the purpose of trying to use all resources available to the health service to help people deal with the problems. I have met representative groups from the region, visited Waterford and listened attentively to what they said. I have sympathy for their position, but sympathy does not solve all the problems. Every effort has been made and consideration given in dealing with this issue to the best of our ability on the basis of progress made thus far.
The Health Service Executive is to withhold payments due to nurses and midwives under the Sustaining Progress agreement and under benchmarking, which fall due on 1 June. What is the Minister's view of what I can only describe as very provocative action? Is he aware that this threatened action by the HSE has evoked a very strong response from the Irish Nurses Organisation, that is, to consider industrial action? Will the Government intervene to encourage the HSE to withdraw immediately its threat to withhold these payments as of 1 June? Will he further encourage the HSE to re-engage with the INO in its ongoing negotiations on health care assistant training programmes and the other outstanding matters? Much has been resolved, although some matters remain to be addressed. Will the Government intervene with the HSE to avert the situation, which is already at crisis point in accident and emergency units, from deteriorating further, with all the serious consequences of industrial action in our hospital services throughout the State?
Will the Minister join me in commending the INO on its campaign, Enough is Enough, which is bringing greater public attention and awareness to the ongoing crisis in our accident and emergency units? Is the Minister aware that as of yesterday, there were 181 people on trolleys in accident and emergency units in various hospitals throughout the country? Can the Minister advise us whether the Tánaiste's so-called solution or part solution to this problem, that is, making further beds available in the already difficult ward situations in hospitals, has made any contribution to alleviating the current crisis? What information can he share with the House regarding that proposition from the Minister for Health and Children?
On the first matter, I understand that is an industrial relations issue that is being dealt with through the usual industrial relations machinery. I hope, as has been the case in the past, that might provide a means by which those issues can be resolved peaceably in an industrial relations sense.
Regarding accident and emergency services, over 1,240,000 attendances are recorded at the accident and emergency services for 2004. That is, on average, 3,300 people per day. As the Tánaiste said, we are committed to improving the experience of patients through sensible and achievable measures. It is not simply a resource issue, although it is so in some cases. As I said here previously when asked about this matter, there is need for co-operation in terms of internal reorganisation of the provisional delivery of services in our acute hospital system if we are to deal with that issue.
They need more beds.
It is not simply a question of beds because more beds have been provided. There is far more throughput of day cases now than was the case in the past.
There is a shortage of beds.
Order.
The Tánaiste indicated in her ten-point plan the short-term measures she wishes to take to deal with those aspects of the service causing greatest difficulties. It is her intention that they will make a difference. She is in the process of getting on with that with the HSE, hospital management, staff and unions to ensure that happens successfully. However, there is a whole range of issues that are inter-dependent in terms of the proper delivery of our health services. It is clear that the availability of general practitioners at all times for primary care services is critical, as is the need to internally reorganise the way we deliver those services within the acute hospital sector. If we can provide the necessary environment and co-operation for that to happen, we can and will see real improvements because the resources have been improved and will be further improved in the future.
The Minister must recognise that it is Government's responsibility and duty to help avert a deterioration of the situation in our accident and emergency units throughout the country and across the range of hospital services, which industrial action would undoubtedly precipitate. Is it enough to say this is a matter of industrial relations? The Health Service Executive and the Government must be aware and acknowledge that the INO has engaged in a very focused and determined way to overcome all the difficulties relating to the health care assistant training programme and related matters. As I said in my initial questioning, it has made significant progress. There are matters outstanding, but against the backdrop of the threatened withholding of payment to nurses and midwives from 1 June, there is now a poisoned atmosphere. This is not a climate that will be conducive to realising the necessary focused engagement between the HSE and the INO.
Does the Minister not recognise that this issue requires intervention at this point, not post the debacle visiting each and every one of us? Will he not also, in recognition of the major contribution nurses, midwives and the INO body make to the overall delivery of health care services in this State, accept it is the duty of Government to take cognisance of their expressed concerns and act accordingly? I do not believe the HSE can depend on Government as a crutch for any and every move it chooses to take. There is a responsibility on Government and on all voices in this House to ensure the crisis of such proportion that threatens is averted. I appeal to the Government to intervene to ensure this matter is addressed positively and sincerely so that the ongoing engagement will be under way and payments will not be withheld on 1 June.
As I said in a previous reply, the question of ministerial intervention as the solution to the problems being spoken about does not comprehensively deal with the issue. Full co-operation from everybody is needed to deal with the issue that has arisen recently in respect of accident and emergency services. The industrial relations machinery should be utilised by everybody for the purpose of finding solutions to these problems. I reiterate, however, that these problems will not be solved on the basis of status quo plus. They will continue to revisit the service if we do not overhaul and reorganise the way we deliver the services in the acute hospital system and how that relates to the availability of primary care, and ensure that people who present to accident and emergency units require the services in those units.
I saw a statistic recently which indicated that four out of five people who present to accident and emergency units are not admitted to hospital. We must ensure that the accident and emergency services that are required by the people who need them are available. We must ensure also that other parts of the service outside the acute hospital sector meet their responsibilities in dealing with patients who do not require accident and emergency treatment or hospital admission. Hospitals are for acute admissions.
We must ensure also that where problems arise in accident and emergency services, hospital management gives priority to reducing elective admissions so that the immediate short-term problem can be dealt with. We need co-operation on the part of everyone to ensure that those who require accident and emergency services get them. It must be said that those experiencing genuine emergencies are dealt with in the health service but we must ensure also that where service pressures arise, elective admissions are reduced to allow those emergencies to be dealt with. That is the way to deal with this issue sensibly, but it requires the co-operation of everybody.