Dáil Éireann debate -
Tuesday, 6 Feb 2007

Vol. 630 No. 5

Leaders’ Questions.

Mr. Kenny

Since I raised the issue last week of operations being cancelled in St. James's Hospital my office has been inundated with the reflections of people all over the country on other operations being cancelled. It must be very dispiriting for professionals to work in the health services given the present position.

Ten years have passed, €60 billion of taxpayers' money has been spent on the health service, there have been three Ministers for Health and Children and the Government still does not seem to realise that there is a serious shortage of acute beds in the country. Last week the Taoiseach said there will always be waiting lists and the Tánaiste and Minister for Justice, Equality and Law Reform, Deputy McDowell, said this is a manufactured crisis, with people in white coats showing concern, and that the Government will not be directed by such a situation. Last week it was St. James's Hospital that was involved and this week it is the Mater Hospital.

BreastCheck was first rolled out in 2000 and there was a specific guarantee that six beds in the Mater Hospital would be left aside specifically for women who required urgent medical attention for cancer and that they would receive intensive treatment from specialists within three weeks. I understand those six beds are no longer available to women who need urgent medical attention for cancer, which is appalling. The guarantee of six beds no longer applies because the figures for accident and emergency units are being massaged. It is all about the trolley count. It is either a question of saving face or saving lives and in this case it appears the Government is more interested in saving face. Will the Taoiseach tell the House that the six beds guaranteed to be ring-fenced for women who require urgent medical attention for cancer will be restored forthwith?

The Taoiseach

The Deputy raised two questions but I believe I answered the one on beds last week. In addition to the HSE's own beds, the number of beds contracted by it this year amounts to approximately 1,300. Some 360 beds are being made available through the private sector, including 220 in the greater Dublin area, 100 in the south and 40 in the western region. Another 1,050 have been taken from the other sectors. The plan of the Minister for Health and Children is to take approximately 1,000 beds out of "cohabiting" hospitals — private hospitals.

Progress is being made on all these issues, as I explained at some length last week. Deputy Kenny does not want to acknowledge the enormous increase in numbers successfully achieved through the winter initiative in the accident and emergency system. There has been a huge reduction in respect of the accident and emergency waiting list. In October, there was a reduction of over 30%, as was the case in November. In December and January, there were reductions of 50% and 57%, respectively. The time people have been waiting has reduced dramatically.

I know about the St. James's Hospital issue and what arose therefrom, as Deputy Kenny probably does also. I acknowledge the pressures on staff in hospitals at this time of the year and also the work they do.

We have invested enormously in cancer services. Many thousands more people have received cancer care. There have been over 40,000 more inpatient treatments and 55,000 more day care cases. The waiting lists for cancer treatment of all kinds have dramatically improved in the past decade. We have over 300 cancer specialist posts and we are building cancer services under the new cancer control strategy of last year, which was welcomed by everybody.

BreastCheck cancer screening does not represent the emergency cancer process, as Deputy Kenny should know. BreastCheck is being rolled out nationally. We are preparing a cervical screening programme, which is due to start later this year. There was no screening programme at all until a few years ago. We are investing in new cancer treatments and we have guaranteed capital funding, including PPP funding, of over €400 million for the radiotherapy network. The HSE will implement the programme over the coming years; it cannot be done all at once.

The new linear accelerators are being installed in St. Luke's hospital and new facilities are being built at Beaumont and St. James's Hospitals. Patients are being treated in Limerick, services will be offered in Waterford Hospital, which is linked to the private hospital in Waterford, and there is capacity in Cork and Galway. Patients in Donegal are being offered treatment in Belfast and there are also arrangements with Galway. All those services are in operation. I have no intention of saying during Leaders' Questions that if any hospital has a certain number of beds linked to anything, or to consultants, those beds should have a certain configuration.

Mr. Kenny

Facts are one thing, statistics are another and human lives are yet another. The Taoiseach read out a list of facts and figures. I said we have spent €60 billion in the past ten years under three Ministers for Health and Children. The Taoiseach has not addressed the human side of any aspect of this matter, bearing in mind that 40,000 operations have been cancelled and 29,000 people are still on waiting lists. There seems to be no understanding any more of what is happening by members of the Government.

In 1997, Fianna Fáil promised the full implementation of the national cancer strategy, including the creation of centres of excellence in Dublin, Cork and Galway and eight regional centres. Ten years on, the programme is not even half way towards completion.

In 2001, the Government promised in the national health strategy that programmes for breast and cervical cancer screening would be extended nationally. Six years later, women, principally, are discriminated against in the provision of the service. More recently, a report on radiation oncology, produced by the HSE and remarked upon by one of its officials, clearly stated the objectives in this area are unachievable in the timeframe set out.

The joint report, published in 2001, concludes that critically ill adults and children are routinely denied intensive care services in Ireland. It states that the cancellation of major surgery and premature discharge are routine and that these practices are known to increase patient mortality. Nevertheless, in the wake of three Ministers for Health and Children, the Taoiseach tells us things are well.

The "NBSP Women's Charter", which deals with emergency cases of women suffering from breast cancer, lists the following aim: "To arrange for you to be admitted for treatment by specialised trained staff within three weeks of diagnosis". It is an emergency when a woman finds a lump in her breast only to discover that a guarantee made nationally that six beds would be available in the Mater Hospital is no longer being honoured. It is all about the trolley count and saving face. Very little of what the Taoiseach read refers to saving lives. It is about time that the Government, in its remaining 100 days before it is voted out of office, decided to focus on the real issues that exist rather than having the Minister for Health and Children tell us that the crises are manufactured by professional personnel in white coats who look concerned about the people who are dying.

Deputies

Hear, hear.

Mr. Kehoe

Shame on the Government.

The Taoiseach

Deputy Kenny should at least research his facts. BreastCheck involves diagnostic work, mainly for women over 50. It is on a precautionary and preventative basis that it is being rolled out. Deputy Kenny may refer to the charter but I launched the programme and am well aware of it.

(Interruptions).

Mr. J. O’Keeffe

He launched a thousand policies.

Mr. P. McGrath

He could have implemented it if he launched it.

Mr. J. O’Keeffe

"Bertie of Troy".

Mr. Rabbitte

He launched more programmes than Cleopatra.

An Ceann Comhairle

Allow the Taoiseach without interruption.

The Taoiseach

That is what BreastCheck is and screening is being rolled out around the country.

The treatment work is such that it is necessary to admit certain people on an inpatient basis or to have them attend for further screening, tests, surgery or operations. Deputy Kenny confused the two areas.

Mr. Durkan

Incredible.

The Taoiseach

The Deputy is correct that it has been said recently that the work cannot be completed by 2011. I cannot accept and have not accepted that additional time is needed to complete the work.

The radiotherapy hospitals in Waterford hospital, which only came on stream two years ago, are fully built and operational. The second accelerator unit is working and it is being used by the National Treatment Purchase Fund——

Mr. O’Shea

They are not in Waterford Hospital.

The Taoiseach

They are in Waterford, in Whitfield.

An Ceann Comhairle

Allow the Taoiseach to speak without interruption.

Mr. O’Shea

They are not in Waterford Hospital.

An Ceann Comhairle

Deputy O'Shea is not the leader of Fine Gael. The House will hear the Taoiseach, without interruption.

Ms Lynch

He is from Waterford and he knows.

Mr. Quinn

If I were the Taoiseach, I should not go there.

The Taoiseach

If he knows, he was at the opening with me, where we went down and saw the accelerators.

Mr. O’Shea

That is a private hospital.

The Taoiseach

I am talking about the Whitfield Clinic, and there is a contract——

Mr. O’Shea

It is not Waterford hospital.

The Taoiseach

It is the Whitfield Clinic, which has a contract with the HSE, where women in the south east and other parts of the country are receiving radiotherapy treatments on this day. Is that not true?

Mr. D. Ahern

They are not listening.

An Ceann Comhairle

The Taoiseach is replying to Deputy Kenny's question.

The Taoiseach

Is it not true that when I was there Deputy O'Shea and others said they would see whether there was a contract signed with the HSE for public patients? Is it not true that this has been done and delivered and that one of the best services in the country is in his constituency, and that I played a part in that?

Deputies

Hear, hear.

Mr. O’Shea

It is not in Waterford hospital.

Mr. D. Ahern

The Deputy should be serious about it.

The Taoiseach

As regards the services I accept Deputy Kenny's point that their roll-out in the private sector, as in the Whitfield Clinic and in Limerick, can be done at enormous speed. To say at the start of 2007 that they cannot achieve a strategy by 2011 is just not acceptable. Given the huge resources and the staff they have been given, they should be able to do it by 2009. I do not accept that and I have said so to the Minister for Health and Children, who in turn has repeated it.

As regards the consultant posts and BreastCheck in particular, the cancer screening programme is being rolled out nationally this year.

Dr. Cowley

What about cervical screening?

An Ceann Comhairle

I ask Deputy Cowley to allow the Taoiseach, without interruption.

Mr. D. Ahern

He is still getting the GMS.

The Taoiseach

In reply to Deputy Kenny, we are preparing a cervical screening programme which will start later this year. It was not the case that we have not got a programme. There was no programme a few years ago. As regards the staff involved now, there are 110 new specialist posts in cancer treatment, giving 300 new cancer specialist posts. There is a cancer control strategy. It is neither reasonable nor fair to say that in this area we have not put in an enormous amount of resources. There are cases, such as the one we saw a few weeks ago that was highlighted by RTE, where I accept somebody had not been seen for months. I have not seen the full facts as regards the case, but that should not happen. It will be interesting to follow it through, but I have not seen the full details. However, we put in the screening processes and we are rolling them out. We have improved services and massively reduced waiting lists. I am not going to do a bed count as regards the Mater or any other hospital, but we are genuinely and honestly putting the resources in and we shall continue to do that. It is not all finished. The final date was 2011, and I accept that. However, we have improved the services dramatically for diagnostic work, radiotherapy — which is not fully completed, I admit, but the programme is in place — and elective work. Matters have improved dramatically. I come across people on waiting lists too. However, services, which were never in place hitherto have been resourced and enhanced around the country.

Mr. Rabbitte

Let the record show that I meant Helen of Troy. I was always beguiled by Liz Taylor.

Will the Taoiseach respond to recent newspaper statements to the effect that estate agents and auctioneers propose to increase their fees by 33% as a result of the apparent slowdown of price acceleration in the housing market? Specifically on behalf of the auctioneers, a gentleman called Mr. Fintan McNamara told the Irish Independent:

During the course of the boom it was very very easy to sell properties. Agents very often were just facilitators in the sale process. Now, however, as the market cools, agents are going to have to use their marketing skills and there will be a lot more work involved.

Will the Taoiseach permit a situation where, for example, the cost of the buying and selling process of an average house will rise from €5,250 to €7,000, on top of all the other charges young people have to pay? I do not recall auctioneers reducing their commissions when prices were going up. It seems the same amount of selling is involved whether the property is €1 million or is an averaged price house. Houses went up by 12% and commercial property values rose in double digits. I do not need to tell the Taoiseach how fraught and harrowing the business of buying a home is. How is it that his Government, however, will defend and protect the interests of developers and anybody with money but not those of young people who are trying to buy a home? Why is the Taoiseach not calling in the Competition Authority to deal with this issue? Why is he not bringing forward the Bill that has been promised for five years, to regulate estate agents and auctioneers who can do and charge what they like? We have seen the malpractices some of them are engaged in highlighted in recent times.

The Taoiseach

I will not defend, condone or stand over developers, auctioneers or agents of any type who engage in this. Regulation of the property services sector, which is vested in the new property regulator services authority, as already outlined in the House in the last session by the Minister for Justice, Equality and Law Reform, will license and regulate management agents, who are often the source of problems as regards service charges and accountability. We had this debate in the House in the autumn. Subject to checking, the heads of the Bill were passed before Christmas and the legislation has gone for drafting. Issues that relate to local authority planning conditions, estates being taken in charge etc. are covered in that legislation. Changes are to be made in company law to help avoid problems such as failure in any of these areas, including what the legislation was particularly meant to deal with, namely, management companies. It was also intended to include all the other areas. The Office of the Director of Corporate Enforcement has issued guidelines in the last few days as regards the governance of these types of companies which will help control the management of the companies. The report points to certain measures that should be taken as regards matters such as charges, dealing, agents, contracts and management company structures.

Perhaps the Office of the Director of Corporate Enforcement cannot do much about the legal end. However, to answer the Deputy's question, the heads of the property regulator services authority legislation have been drafted and are designed to deal with the point the Deputy has raised. There is also——

Mr. O’Dowd

Let us move on to the next hope.

The Taoiseach

We have already got the heads of the Bill in place. In terms of the matter raised by Deputy Rabbitte, it is the seller who pays the auctioneer, not the buyer. For once I agree with him that there is no argument whatsoever to be made or any justifiable case for auctioneers to have any increase, having worked on the basis of 30,000 to 35,000 a year, while they are now selling in the range of 94,000 and that figure might drop to 88,000. There is a process involving the Competition Authority where one can get an auctioneer's licence. It may be a bit cumbersome, but it must be regulated. The only way to deal with it is by having more competition.

Deputy Rabbitte asked me why I would condone this sort of thing. We are not condoning it. The heads of the property services regulatory authority Bill went before the Government before Christmas. This Bill will license and regulate management agents, who are the source of these problems. That will hopefully help the costs.

Mr. Rabbitte

Of all the rambling, meandering, irrelevant answers that the Taoiseach has ever given in the House, that is the worst of them.

Mr. Durkan

First prize.

The Taoiseach

The Deputy does not want me to legislate.

Mr. Rabbitte

The Bill to deal with management companies, which we have raised on these benches so many times, has got absolutely nothing to do with the Taoiseach's friends in the auctioneering business. A Bill has been promised by the Minister for Justice, Equality and Law Reform for five years to deal with the regulation and licensing of auctioneers. There is no sign of it and no prospect of it coming before this House.

The Taoiseach saw the excellent "Prime Time" programme which exposed the practices that are going on in the industry, such as the practice of inventing bids and ghost bidders which put up the prices. The Taoiseach will have to point out to me the person who sells a home but who does not have to buy a home. Where I live, anybody who sells a home must buy a home, so I do not know what point the Taoiseach is making.

An Ceann Comhairle

The Deputy's time has concluded.

Mr. Rabbitte

A very eminent Member of the other House wrote an article recently about how to become a member of the auctioneers' association. He is now trading, although I do not know if he is doing any business. He says that as long as one pays a bond of €12,700 and one does not have a police record, one can start out as an auctioneer. In his article, he states:

Today I can advertise as an auctioneer; I can buy and sell houses for commission; I can advise on guide prices; I can conduct auctions galore; I can gazump until the cows come home. Best of all, I can take in buckets of money from a gullible public. I am not subject to the prying inspections of the financial regulator, the Central Bank, any fig-leaf of an auctioneers' body — or anyone else.

An Ceann Comhairle

The Deputy's time has concluded.

Mr. Rabbitte

That is the actual situation. There is no regulation and there is no licensing. Judging from what the Taoiseach has said, he has no intention of sending the Competition Authority after these guys. This is a disgrace. After all the money that has been creamed off in the last 15 years, they are threatening to put up fees by 33% because the price of houses will not rise at the same rate as they have in the last ten years. It is an outrage and the Government needs to act on it, rather than talking about planning and development conditions, management companies and any other sand the Taoiseach thinks he can throw in the eyes of the public.

An Ceann Comhairle

I ask the Deputy to give way to the Taoiseach.

Mr. F. McGrath

Do not buy a house from Senator Ross.

The Taoiseach

If I give a long answer, the Deputy gets confused, so I will give a short answer.

(Interruptions).

An Ceann Comhairle

Allow the Taoiseach to continue without interruption please.

The Taoiseach

I said to Deputy Rabbitte that the heads of the property services regulatory authority Bill were published before Christmas. The Bill will be responsible for auctioneers, estate agencies and management agencies. That is precisely the issue that the Deputy raised today. The Minister for Justice, Equality and Law Reform set up a working group on the regulation of auctioneers. I understand that was a public group and the Labour Party made no submission to it. Under current competition rules, auctioneers are not allowed to fix fees, so it is not the case that they can do anything, as the eminent Member of the Upper House suggested. I thought Senator Ross was in another profession, but maybe he is an auctioneer as well. Auctioneers usually arrange fees in agreement with the public, but under competition rules they are not allowed to fix fees. If Deputy Rabbitte thinks they are involved in that, they are breaking competition rules.

It is inevitable that things move up and down as market forces come into play. If the houses are not being sold, auctioneers will not have the staff. We have proposed legislation and we have published the heads of a Bill that is responsible for auctioneers and agents. The working group of the Tánaiste and Minister for Justice, Equality and Law Reform will examine and regulate auctioneers and it is still in operation. Under competition rules, they are not allowed to fix fees.

Mr. Rabbitte

Where is the Bill on the list?

An Ceann Comhairle

The Taoiseach without interruption; there is no provision for a third supplementary question.

The Taoiseach

I commented on the management fees because that issue is also relevant. The Bill will protect management companies that also affect young people, which was a part of these proposals.

Mr. J. Higgins

Is the Government taking any emergency measures to rescue half of the population of this State from the shocking debacle that the Taoiseach has allowed to develop in the area of private health insurance? Is there the slightest hint of embarrassment in his Government that the policy of privatisation he has pursued for ten years has, in this particular instance, become a monster that is stalking the health needs of our people, thirsting for the maximisation of profit, threatening further sharp increases in the double tax known as private health insurance and threatening to end the concept of community rating?

The Minister for Health and Children was warned last July that speculators could drive a coach and six through the legislation in this area, that big snouts were lining themselves up at the trough to organise another smash and grab raid for a further three years, and then walk away with the proceeds. Why was there not an immediate response from the Minister for Health and Children and from the Government? The Quinn Direct-BUPA Ireland wolf is not just at the door, but in the bed masquerading as a newborn babe. The Minister, Deputy Harney, is standing by like a bemused Little Red Riding Hood, saying "Oh Mr. Quinn, what big teeth you have, what a big appetite for profits, tut tut". Meanwhile, BUPA has walked away with up to €100 million in profit, soaked from ordinary people who have been double taxed as they feel they must have private insurance due to the Government's failure to provide a just and equal health service.

The owners of Quinn Direct may know a lot about mixing concrete but nothing about health care, yet they think they can walk away over the next three years with another €100 million. A measure of the contempt which they have for the old, the sick and the handicapped can be seen in one of today's newspapers, in which they suggest that some of the VHI clients could be transferred to them. A few old people can be thrown to them to cover their backs and everything will be all right, as if our elderly patients were sacks of cement to be offloaded from one pick-up truck to another.

What is the Government's position on this debacle? Did the Cabinet discuss this issue this morning? Will we have emergency legislation to curb the greed of these private profiteers who are determined to trash any concept of equality in the health service? They are parasites because they are thriving on human necessity. What is the Taoiseach's position?

The Taoiseach

I am not too sure what question the Deputy wants to ask me. If he wants the——

Mr. J. Higgins

The question is very simple. I can help the Taoiseach.

An Ceann Comhairle

Please allow the Taoiseach to answer.

Mr. J. Higgins

He is not sure.

An Ceann Comhairle

We are two minutes over time.

Mr. J. Higgins

I could not be clearer.

An Ceann Comhairle

Please allow the Taoiseach to continue without interruption.

Mr. J. Higgins

Will the Taoiseach introduce emergency legislation to stop speculators walking all over ordinary people who wish to retain their private health insurance?

Mr. Brennan

The Deputy wants to let 300 jobs go.

Mr. J. Higgins

Will he ensure speculators will not walk away with a fortune, while smashing the concept of community rating?

Mr. N. Dempsey

That was a second question.

The Taoiseach

The Health Insurance Act 1994 and the Health Insurance (Amendment) Act 2003 provide for the regulations, whereby new entrants can participate in the health insurance sector. The Government wants to see Quinn Direct's proposals which will be examined by the Irish Financial Services Regulatory Authority. We will have to see the arrangements in the contract drawn up when Quinn Direct purchased BUPA Ireland before we can make a decision. We are taking legal advice on how we should handle the position. We have to consider the employment position and take into account BUPA's 400,000 policyholders. We have to see the structure that Quinn Direct will have for its new corporate entity. The Barrington group has been examining the proposals and the case made by a number of insurance companies, including VHI Healthcare. The Government hopes to complete this process as quickly as it can. The first issue we will have to examine is that of the arrangement of the new corporate entity. We will have to consider how it fits in with the 1994 and 2003 Acts. It may be outside the scope of the Acts — it may not have been foreseen by them. While that is what it looks like, we cannot be sure until we know the full position. For example, we will have to see the application that Quinn Direct will make to the Irish Financial Services Regulatory Authority and the Health Insurance Authority. We cannot be certain until then. We will have to deal with a number of important issues. We discussed the matter earlier today. We have had a number of meetings. The Health Insurance Authority is also examining the issue. We will have to try to make some early decisions on it.

Mr. J. Higgins

Why has this matter been left until the eleventh hour, when the damage may well already have been done? Why did the Government not react immediately when the issue was flagged last July? It is clear that there is no urgency on this issue. Such negligence of the highest kind reflects the Government's bias in favour of those who see the human and health needs of people simply as a cold marketplace in which business can be conducted and profit made. The big business interests which are moving into the health care sector for private profit — I refer to speculators and beef barons, etc. — do not take the Minister for Health and Children, Deputy Harney, seriously in any sense as a defender of public health. Why should they, given that she is robbing land from public hospitals and giving it to private hospitals and then lecturing the consultants because they want to moonlight in those private hospitals? How can they take her seriously in such circumstances? Community rating is based on a concept of equality among human beings, but the Minister represents a party which promotes inequality. I refer to the Progressive Democrats, which advocates a system "red in tooth and claw". The Minister is on the same wavelength as those who are poised to make a killing on foot of people's private health insurance needs.

Does the Taoiseach agree that ordinary working people who pay massive amounts of taxation should not feel pressurised to take out private health insurance? They are under such pressure because the Government is incapable of providing a health service in which they can be seen immediately and efficiently. I ask the Taoiseach again to tell the House, on foot of the advice given to the Cabinet this morning, what the most likely outcome to this problem is. Will Quinn Direct be given a three-year period of grace, after which some other so-called entrepreneur will be able to move into the health insurance field in its place and walk away with another fortune? What will the Taoiseach do to stop this scandal?

The Taoiseach

A number of important issues arise in this regard. The 400,000 who use BUPA Ireland's service want to continue to avail of private health insurance and have their policies protected. We should consider the staff of BUPA Ireland and the position of VHI Healthcare which expects to receive resources from the private health insurance operators under existing legislation which did not envisage the circumstances which have arisen. We will have to wait to see what form the new corporate entity will take. It appears, on the face of it, that the underwriting company has been dealt with in a different way. It seems that it is outside the scope of the legislation. We will have to take legal advice on how to handle this. We will need to see whether Quinn Direct gets a licence from the Irish Financial Services Regulatory Authority and the Health Insurance Authority. We will need to take account of the positions of the other private health insurance companies such as VHI Healthcare. The Barrington group which is already looking at that issue has been taking account of——

Mr. J. Higgins

It has been doing so since last July.

The Taoiseach

Actually, it has not been doing it since last July. The first I heard about Quinn Direct taking over was in the House last Wednesday. It only came into the equation a few days before that, as I understand it. I did not know of its interest until last Wednesday. I have no brief for Quinn Direct which employs 6,500 people. I do not know if it is right for Deputy Higgins to feel it necessary to describe a company which employs 6,500 people in the economy as the beast at the trough, or the wolf at the trough. It is disrespectful to describe the company, for which I have no brief, in such a manner.

Deputies

Hear, hear.

The Taoiseach

We have to resolve some issues relating to the Health Insurance Act. The Attorney General is examining the matter and we are getting some outside advice. I do not think we can resolve the matter before the ongoing work of the Barrington group has been completed. We need to examine precisely how Quinn Direct intends to compose its corporate entity. We have to deal with such issues and will do so. I do not think the matter can be dealt with in the next day or two. I do not want somebody to think it can be resolved tomorrow. It is likely that Quinn Direct will not apply for an IFSRA licence for some time. The Health Insurance Authority will have to deal with such an application. The report of the Barrington commission is not due until next month.