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Dáil Éireann debate -
Tuesday, 3 Apr 2007

Vol. 635 No. 1

Leaders’ Questions.

The current dispute involving work to rule by 40,000 nurses is an example of the Government's failure creatively to pre-empt a crisis that threatens the delivery of fundamental quality health services in the State. As a consequence, it fails patients, taxpayers and front-line workers. It is more than three years since I proposed that the benchmarking process was not capable of dealing with all of the areas and sectors it was required to deal with so that transparency, clear services and improvements for the public could be brought about in return for these rewards.

The Government has rejected all challenges to reform what is a flawed benchmarking process. With a work to rule involving 40,000 nurses, we now have a situation where nobody — nurses, patients or the public — benefits as a consequence. In reminding the Taoiseach and the Government that nurses have signalled their willingness to change work practices and introduce efficiencies and have indicated their willingness not to be seen as obstructionist in this matter, I suggest that the unwillingness of the Government to consider changes to the criteria and flexibility of the benchmarking process has brought about this impasse where everybody is suffering. The Government has known this for some time. My party and other organisations have made the point that benchmarking does not suit every situation and should be altered to cater for discussion and negotiation of legitimate claims.

Is the Taoiseach prepared to say that the current work to rule is a consequence of a flawed benchmarking process? Furthermore, is he prepared to say on behalf of the Government that a willingness to reform that process might have avoided this dispute?

Is he prepared to apologise on behalf of the Government to taxpayers, patients and nurses for standing over a system that is inherently flawed and incapable of what it was set up to do in the first place?

I will try to explain the issue briefly. The current dispute has nothing to do with the benchmarking process whatever. Effectively, the dispute is about two issues, namely the agreement on a 35-hour week from an early date and the elimination of a pay anomaly as a result of a series of pay adjustments for nurses and midwives who are paid less that assistant house parents despite having higher professional qualifications and responsibility, including responsibility for assistant house parents.

The Labour Court examined the issues in dispute and said the best way of dealing with them was through the benchmarking process. The nurses unions, the INO and the PNA, have given consideration to those issues. On the reduced hours, the management side's position is that a timeframe for a reduction in the hours could not be set without first carrying out a detailed risk assessment which would have to include the involvement of the relevant stakeholders. Management has no objection in principle to reduced hours but cannot give a definitive commitment as to the pace and the scale of reduction without more careful consideration. I have said many times that I acknowledge that the nurses unions are prepared to try to make this cost neutral but the management side or the Government, and the taxpayer, cannot go into that unless the work is done. The Government management side would say let us do the work and see if this can be cost neutral but the union side asked when it would be completed and said they would then enter into it. A reduction to a 35-hour working week effectively means about 30 extra days off for each of the individual 40,000 nurses, which would represent a massive change in working arrangements. It might be possible — I am not saying it is not possible — but the work needs to be done on it. Some work has been done on it but not a lot. It involves a reduction of 7.7 million nursing hours so it cannot be undertaken lightly. It has nothing to do with benchmarking.

While the pay anomaly should be a simpler issue the management side is prepared to regrade the particular nursing personnel who have responsibility for supervising staff with salaries in excess of the staff nurse scale. They contend, however, that the more general issue of the appropriate rate for the staff nurse grade is a matter for the benchmarking body. If that is the case there are 44 or 45 people involved. The argument of the nurse leaders is that anomaly should be reflected for all 40,000 nurses. It is either an anomaly for the nurses midwives grade but it is certainly not an anomaly for 40,000 nurses.

In regard to what is on offer on the nurses side in respect of the reduced working hours, the management position in line with the recommendation of the Labour Court is that it is prepared to address the changes in the organisation, the management and the delivery of health care which it could facilitate and a reduction in the standard working hours for nurses and midwives. That can be negotiated through the benchmarking body or wherever. The issue is not where it should be done, it can be done anywhere. Last week the NIB was trying to find a basis on which to move it on. We are trying to find a basis were it could move it on. We are still prepared to try it or any other mechanism, it does not have to be done through the benchmarking process.

On the issue of the pay anomaly the Labour Court said that issue should be dealt with through benchmarking. The management side is prepared to regrade the particular nursing personnel who have responsibility in excess of the nurse grade so as to remove the particular anomaly. On the more general point of a 10.6% increase for all nurses, this is a matter for the benchmarking body. It is due to start to report later this year. Other nursing trade unions have already made submissions in this regard. I should point out that the 10.6% pay claim is in addition to the 10% currently available in return for signing up to Towards 2016. The last point, one I made earlier to Deputy Kenny, is that the terms of reference and the criteria for the next benchmarking round have already been agreed with the unions, including SIPTU which has a large number of nurses unions. It is not an inflexible system, it is one that has already been negotiated with the trade unions and everyone knows the rules of the process.

The time available to the Taoiseach has expired.

Arising from the Taoiseach's reply, I remind him of the terms of the letter of 9 March 2007 which he sent to the Irish Nurses Organisation indicating that the Government representatives and the Minister for Health and Children would involve themselves in the intensive discussion process and would be as open and creative as possible in achieving outcomes for the benefit of nurses and patients alike. What was the political mandate given to the NIB in those discussions? It appears, and I do not have access to all the information, as if the creativeness and openness was coming from only one side. Will the Taoiseach indicate one or two examples of the openness and the creativity that was coming with the political imperative, through the NIB, to achieve the reductions of which he speaks? In other words, there was a three week process of intensive discussions. In his letter the Taoiseach indicated that the Minister for Health and Children and the NIB would be open and creative in the way in which it went about this. Can he give examples of that openness and creativity, against the background of a dispute which nobody wants to escalate and which, as I said during questions to the Taoiseach, does not help patient, nurse or taxpayer?

That is a very fair question. I will try to keep the issues simple and to the point. Agreement on a 35-hour working week at an early date is what the nurses are seeking. Management is prepared to concede that in principle and to start the first round at a relatively early date. That was discussed at the negotiations but I do not want to breach on something where they had their own walls around the discussions. That was the first issue. They agreed to work intensely to see how on a cost neutral basis this will work out given the loss of 7.7 million hours. That work cannot be done in a week or two, it will take some more time. In fairness to the nurses side, they say they are prepared to engage in that work but want a definite date on completion before they start the process. That is the obvious difficulty. That is creative enough if they agree to do the work. If one agrees to the 35-hour working week, the process will take a few years because every nurse will lose about 30 days per year.

The second issue was the pay anomaly. The management side does not have a difficulty with addressing the pay anomaly for those who suffer the anomaly. That issue was raised in the discussions and should be cleared up. The third issue is that Towards 2016 provides for a 10% increase for nurses. If they sign up to it they are entitled to that 10% increase. We should not forget they are entitled to that increase. The fourth issue is what I think is the impossible one. I do not see this as an imaginative issue. The Labour Court has looked at this at length. The NIB looked at it for three weeks at length. One cannot roll on the anomalous grade of 40 to 45 people and give that to everyone to solve an anomaly and give a 10.6% increase to everybody. Given that an agreement is in place under Towards 2016 it is impossible for a Government to give it.

The Taoiseach had no problem doing it for the barristers and solicitors in the tribunals, but he makes an exception for the nurses. The Taoiseach should show some consistency

Hear, hear.

Please Deputy, it is Deputy Kenny's question.

That would be claimed straight away by the entire 320,000 public servants who have signed up to the agreement. That end of the argument must go into the benchmarking process. The other two or three are possibilities, although I do not know whether that has to continue in NIB or some other one. That aspect of it, however, must go into the benchmarking process because that is what everybody else it in. It is not a question of being difficult with the nurses, but one cannot take any element out of that as it is just not possible to do so, and certainly not for a group with 40,000 members.

I am conscious that this is the Taoiseach's last time, perhaps ever, to answer Leaders' Questions.

I promise the Deputy that is wishful thinking.

I know how important the meeting with Dr. Paisley and Mr. Adams is in the morning, although it is regrettable it was not possible to schedule it around Leaders' Questions. I will make one last attempt to ask the Taoiseach, as Head of Government, whether he will cause these contracts to be signed to build super, private clinics on the campuses of public hospitals. I have been getting a volume of letters and e-mails on this issue. I suspect the Taoiseach has also been receiving such correspondence, as have his backbenchers, given that they are so disquieted about this. It shows the depth of concern among health professionals and the public about the new drift of Government policy. I will read a paragraph from one consultant, which fairly much reflects feelings on this matter. Talking about the private capacity, he states:

They have a real potential to run down the public system and can reduce it to providing core services such as complex medical problems and providing care to acutely ill patients who cannot be catered for in any private system. So the profitable areas will be creamed off to be done in the private system. In addition to that, they have a disastrous effect on medical training. In short, I agree they will not solve any of the current problems. At present, what is happening in our acute hospitals is nothing short of a national crisis. The A&E departments are not able to cope and figures that are trotted out by the HSE are very dubious.

The Deputy's time has concluded.

I am glad I had finished the quote then. That quotation is fairly representative of the view of health professionals in nursing and other white collar professional grades, consultants and doctors. Last week I quoted for the Taoiseach the statement on behalf of accident and emergency consultants who said that not only would we have a two-tier health system but we would also have a two-tier casualty system. The Taoiseach tore up his own health strategy to provide 3,000 beds in favour of this new shift towards for-profit medicine. The Irish people do not want an American for-profit health model. They know that we badly need the land concerned to provide community care and step-down beds to take people who are inappropriately occupying beds in acute hospitals out of the hospitals, thus putting them into that kind of care and freeing up beds in the acute hospitals. The Taoiseach is going in the opposite direction, however. Everybody is counselling him against it, including his backbenchers who are excessively glum about this, and properly so. As this is likely to be the Taoiseach's last time on Leaders' Questions, will he permit that, as Head of Government, to satisfy a crazy Progressive Democrats ideology?

On the Deputy's first question, I understand that 90% of the documentation to enable bidders to tender has gone out to the individuals. The formal quest for tender is on the HSE board's agenda for Friday week, 13 April. The formal bid for tender would not issue until after that meeting, so that is the formal position.

I agree with the Deputy that acute hospitals have their difficulties, in spite of the enormous amount of resources, staff, equipment and capital they have received. Part of the solution is to contract nursing home beds in the private and public sectors, and building step-down facilities, which is happening in parts of the country. In other areas, such facilities are required. I do not believe this initiative cuts across that. The aim of the initiative is to transfer private activity from within the public hospital system to new privately-financed and managed hospitals, thereby freeing up 1,000 additional beds for public patients. The new facilities will have to meet specific requirements, for example, the ability to admit private patients 24 hours a day, seven days a week from public hospitals, accident and emergency departments and GPs, with the capacity to treat all patients currently catered for in the public hospital system through joint clinical governance. I accept the Deputy's point that people have written to him about that, but they are not talking about what the HSE is proposing. The HSE has made its position absolutely clear on the accident and emergency departments, GP and 24-hour issues. People may have a point, but it is not what the HSE has said.

Obviously, the HSE will make its own decision at that board meeting but my understanding is that it has reduced the number. The executive is looking at the following hospitals: Limerick, Waterford, Cork, St. James's, Beaumont, Connolly — which is Blanchardstown — Tallaght and Sligo. There will be a rigorous financial assessment of the proposals, which are subject to planning, including the value of the public site and the cost of any tax expenditure foregone. As I said previously, the lease of public land will be on a commercial basis, it will fully protect the public interest and there will be full adherence to public procurement law and best practice. That is where the negotiations currently are and the next move will be on Friday week at the HSE board meeting.

Is the Taoiseach saying that 90% of the bidding documents have issued and that they will be back by the time the HSE board meets on Friday week? Does he expect a decision to be made on Friday week? What is the process after that? What is the duration of the lease in question? How does it materially matter if a building is physically constructed for the next 99 years on this scarce public land? How can the Taoiseach say that professionals in the service do not know what the HSE has in mind? They include people who work at the coalface, consultants, those who have arguably money to gain from working in the private sector and who argue that the migration of personnel will make the public health service worse. They say it will damage the two-tier divide in our service, creating a new two-tier divide in accident and emergency units.

The Deputy's time has concluded.

How can it be argued that these people do not know what they are talking about? It is not a HSE initiative. As recently as 29 March this year, the Minister for Health and Children made a statement in the House and Government backbenchers should read up on it. They cannot go around the doorsteps whispering that this is a Harney-McDowell frolic. The Minister, Deputy Harney, stated, "In July 2005, following Government approval, I issued a policy direction to the Health Service Executive to develop co-located private hospitals on the sites of public hospitals".

The Deputy's time has concluded.

Those are the Minister's words. It was a ministerial instruction.

This is Government policy, not a HSE initiative. Will the Taoiseach tell us whether the investors are likely to get the go-ahead at the board meeting on Friday week?

What is the position on the consultants' contract? I understand that this relevant aspect of the public-private element of the common contract will emerge largely unaltered in which case this would be inoperable in any event.

Regarding the process, 90% of the documentation to enable bidders to tender has been sent and the formal request for tender is on the HSE board agenda for Friday week. Formal tender bids have not been issued and will not be issued until after that meeting.

I wish to reiterate two points I have made on many occasions. I have seen letters on the argument relating to accident and emergency services. The new facilities will have to meet specific requirements including the ability to admit private patients 24 hours a day, seven days a week from the public hospital, from the accident and emergency department and from general practitioners, and they will have to have the capacity to treat all patients currently catered for in the public hospital and through joint governance. There will be one entrance to the accident and emergency department on the campus so the idea that people will be refused, as the Deputy suggested last week and today, is false.

The accident and emergency consultants say that.

It is not true. There will be one entrance to the accident and emergency service on one campus and there will be joint clinical governance.

Private to the right, public to the left.

The accident and emergency consultants' point does not hold up in this regard. This is what currently happens in co-located hospitals and there are no accident and emergency services in these hospitals at present. This has worked in many hospitals, such as the Mater Hospital, St. Vincent's Hospital and in Cork, for many years. The aim of the initiative, to transfer private activity from the public hospital system to privately financed and managed hospitals and free up 1,000 beds, has not changed. As I said here recently when discussing infrastructural issues, the private sector will build this more quickly, by a matter of years, than the public sector, depending on the contract the HSE presents based on technical legal advice. The length of time involved in getting from A to B on building matters through public procurement contracts is too great.

The Taoiseach is in charge of such matters.

A Deputy

Speed it up.

We are speeding it up. We are allowing the private sector to build in these locations. Several other hospitals were cleared some years ago and jumping through all of the hoops creates much of the difficulty, alongside a rising population.

This is quite an admission of failure.

I have made this admission several times. There has been a substantial increase in the number of beds, it is in the region of 1,482, but it is not enough. This provides a quick way to build and to move private patients from public hospitals to private hospitals on co-located sites with joint clinical governance. If I thought this process would bring about a two tier health system or create difficulties I would not be so supportive of it.

What does the Taoiseach think will happen?

I will not argue with Deputy Rabbitte.

I ask that the Taoiseach argue with me.

I will not. I do not see how private patients in public beds help public hospitals.

They are entitled to public beds.

It is preferable that a private patient be treated in a private hospital on a co-located site. I do not see how this can damage the health service

There are those who are blind and those who will not see.

This system has existed for some 100 years on a number of sites of co-located hospitals in the country.

That is not the case.

I was reading through the Government's latest national climate change strategy and I concede that it makes interesting reading. The brazen statement that Ireland is meeting its commitments jumps out from page 15 and surely the Taoiseach knows this statement is false. Regarding the Kyoto Protocol, Ireland is 25.4% over 1990 levels and rising so the contents of this report are downright lies. I ask the Taoiseach to correct these fallacies because it is wrong for the Government to give out facts that are not in keeping with the truth.

The Government's first strategy on climate change was not implemented so how can we trust it to implement the second strategy? The Government did not implement the carbon tax and it promised that the Moneypoint power station would switch from coal which did not happen. The Government promised a rebalancing of vehicle registration tax, which did not happen under the first strategy and has been kicked into the future. There are many other examples of this nature.

In spite of the dishonesty already evident in this plan, that there is no costing for compact fluorescent lamp, CFL, light bulb plans and no timeframes that one might expect, the Taoiseach importantly said there will be a reduction of 20% below 1990 levels by 2020, based on the EU agreement. I take the Taoiseach at his word on this and presume he knows the implications. In 2005, the latest figures available, we were emitting 70 million tonnes and a level 20% below 1990 levels would allow us emit a maximum of 44.8 tonnes. This requires a reduction of more than 25 million tonnes of CO2, or a third of the current level.

If the Taoiseach thinks the Northern peace process was difficult, changing to a post-oil economy is of a far greater magnitude. Carbon trading will not be affordable; the Taoiseach has provided €270 million for this purpose but, according to experts on renewable energy, the actual cost will be €1.5 billion by 2020. Will the Taoiseach create legislation that will require us to reduce carbon emissions each year by, say 3%, on the previous year? Will the Taoiseach indicate when this will be done or how will he arrive at the 20% cut he has said will happen?

I will not go through the entire document as Deputy Sargent is reading it but it sets out in a detailed way the comprehensive measures we have put in place to enable us to meet the target set under the Kyoto Protocol. All of the preparatory work in this respect sought to set out how this could be achieved. The national climate change strategy requires co-ordination throughout the Government because without this it will not be possible to meet the commitments made under the Kyoto Protocol. The strategy builds on progress already made through the original national climate change strategy of seven years ago.

To what progress is the Taoiseach referring? The situation is worse than ever.

The strategy addresses measures across all sectors of the economy and encompasses energy, agriculture, transport, the residential sector and the commercial sector. It includes measures that have been enacted through the national development plan, Transport 21, the White Paper on energy and the bio-energy action plan, in addition to a series of measures to put Ireland on a path to a low carbon economy.

Transport emissions increased by 7% last year.

It is not just one issue; they all have to be looked at collectively. I assume the Green Party welcomes the fact that we have put all these updated documents into the strategy.

Doing a marvellous job.

The strategy is a fiction.

In light of the recent agreements of EU leaders to reduce emissions to at least 20% below the 1990 levels by 2020, the strategy looks beyond Kyoto. Deputy Sargent is right that this is a challenging task and we must take a longer term view. This was done, particularly in relation to renewable energy targets and investment in public transport to ensure the country is better positioned to meet the challenge of more ambitious targets in the post-2012 period. The strategy across all the areas is set out in detail.

On the flexible mechanisms under which developed countries will support the development of clean technology in the developing world in return for emissions, as Deputy Sargent said, we have allocated €270 million in the national development plan——

It is taxpayers' money.

——for investment in such projects over the lifetime of the strategy. In all of the other areas we have spelt out what are the targets and what action is needed to deal with them. If this is not in one document, it is taken collectively in the four documents I have mentioned.

The Taoiseach is the personification of a flexible mechanism but we need firm mechanisms. He is correct that we face a challenge. Why was he not present at the launch of the document, given the serious repercussions it has for the country? He sent along his royal smugness, the Minister for the Environment, Heritage and Local Government, Deputy Roche, who does not carry the weight the strategy deserves. As this is a cross-departmental matter, the Taoiseach should have been present at the launch to let it be known that it would affect every Department. He had no problem leading from the front on the second referendum on the Nice treaty. I challenge the view that it does not have the same importance. Unless we achieve annual reductions in carbon emissions of 3%, we will not achieve the objective. The strategy does not have a commitment to a targeted annual reduction. The Green Party has worked out that, under this plan, the total reduction in emissions after four years will be 3%. That is not up to the mark.

The business as usual approach proposed by the Government will have a cost. For example, carbon trading will cost far more than the figure of €270 million cited by the Taoiseach. It will also have a cost in terms of flooding and it is having an enormous cost in terms of water contamination in Galway. The poor will be hit hardest internationally, resulting in increased immigration as many people ask why they should not come here given that Ireland will not be as badly affected by climate change as their home countries.

Britain has introduced a carbon budget system under which it will be able to measure its achievements annually, while Governor Schwarzenegger in California has established a strategy in law. Rather than dealing in fiction by engaging in spin in advance of an election, will the Taoiseach not accept best international advice and establish a climate change targets Bill? I ask him to use the Bill published by the Green Party as a template.

We will look at all proposals. The proposals made yesterday include a mechanism to check annually that we are delivering.

It will be to check that emissions are increasing every year.

Deputy Sargent will see this when he gets the proposals. The strategy includes a wide range of measures over and above those already in place from the review, as the Deputy must acknowledge. Fifteen per cent of electricity is to be generated from renewable sources by 2010 and 33% by 2020. It does not have to be a 3% figure in every year. It is an average figure.

An annual reduction of 3% is required to reach the target.

Biomass is to contribute up to 30% of energy input at peat stations by 2015.

All we hear from the Taoiseach is hot air.

There will be a shift to public transport as a result of Transport 21 investment and the rebalancing of VRT and motor taxation. I would have expected the Green Party to favour revised building regulations which aim for a 40% improvement in thermal performance. The grants for renewable energy heating available under the greener homes scheme have been an enormous success. The strategy also includes support for eco-efficient technology and practices, a top-up of EU premium for energy crops and the biomass harvesting scheme. A commission on climate change will provide high level advice to the Government on progress and increase awareness in all sectors. We argue that our strategy is better than the British system and helps to keep the economy efficient. Those are just a small number of the issues that have been outlined and the targets to be met. The strategy includes a commitment to publish another climate change strategy——-

When this one fails.

——for the period after the 2012 commitments. It is laid out for the long term. I hope the Green Party will take a look at it so that they will be able to get their heads around how it might work.

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