Dáil Éireann debate -
Tuesday, 24 Apr 2007

Vol. 636 No. 1

Leaders’ Questions.

Mr. Kenny

My thoughts today are with the people of Enniscorthy in County Wexford and the unspeakable tragedy which is unfolding before our eyes. It is a scar on the conscience of the provision of our mental health services. I do not wish to dwell on this appalling tragedy today.

As we approach the Taoiseach's naming of the date for the dissolution of the 29th Dáil, the people have a clear choice between a tired and jaded Government and the opportunity to elect a Fine Gael and Labour Government full of energy and commitment. Confusion seems to exist among the Taoiseach's backbenchers throughout the country because when one is so long in office it is difficult to distinguish between the people's interest, property and resources and those of the party. This is why, as we approach the death knell of the 29th Dáil, I want reassurance from the Taoiseach.

Prior to the 2004 local and European elections, at least two Ministers used the official resources of the State to support party political campaigns. The then Minister for Education and Science, Deputy Noel Dempsey, commandeered material from the Department of Education and Science and the then Minister of State at the Department of Enterprise, Trade and Employment commandeered the resources of that Department. On 28 April 2004, the Taoiseach confirmed they had breached the code of conduct and quite rightly reminded all Ministers to comply with that code of conduct. His words were, "The rules are tight now and we must comply with them". I accept that.

The Taoiseach will name the day shortly, as is his sole and personal prerogative. Is it still his view that there is no breach by office holders in respect of such material under the code of conduct and there is no excuse for breaching the code which prohibits the use of public resources for party political purposes? On the eve of this great battle, will the Taoiseach assure the House that Ministers in his Government are not using and will not use official facilities and resources for party political purposes?

The Taoiseach

As Deputy Kenny did at the beginning of his contribution, I offer to the extended family and friends of Adrian and Ciara Dunne and their two little girls our profound sympathies at this terrible time. I offer sympathy to the extended community in Monageer and the people of Wexford generally, who are left to come to terms with this issue. The Government discussed the matter and the Minister of State with responsibility for children, Deputy Brian Lenihan, has already stated the Government position.

With regard to Deputy Kenny's question, I confirm that the procedures as outlined in legislation and the code of practice from the Government secretariat have been given to every Minister. They outline how such Ministers must comply with the Electoral Acts and the judgment of the Supreme Court in 2002, and how all the facilities that would normally be allowable would be utilised in the course of the campaign.

Mr. Kenny

I thank the Taoiseach for his reply in which he indicated that the information has been given to every Minister, they must comply with the procedures and that obviously there is no abuse of facilities or resources. I have heard that before and, unfortunately, there is some explaining to be done.

Last week, the Fianna Fáil press director circulated a number of documents relating to the launch by the Minister for Finance, Deputy Cowen, and the Minister for Enterprise, Trade and Employment, Deputy Martin, of proposed policy in respect of employment and jobs. One of the documents is entitled Keeping Ireland Working: The Next Steps Forward. In examining the electronic version of this document, under the properties and author heading, one can see the author is the Department of Enterprise, Trade and Employment. After hearing the Taoiseach's comments I would like an explanation as to why a political party, which is clearly partisan in its nature, can have election campaign documents authored by using facilities and resources from a Department, for which the taxpayer pays. Departments are supposedly impartial by nature and are funded by the taxpayer.

In advance of this great gladiatorial electoral contest, will the Taoiseach indicate who, within the Department of Enterprise, Trade and Employment, worked on the Fianna Fáil document and which State facilities were used to produce it? Does the Taoiseach think it right and proper for a Department to be used in this fashion, particularly as these rules were circulated to all Ministers? Are any other Fianna Fáil propaganda exercises being created by Departments and funded by the taxpayer?

An Ceann Comhairle

The Deputy's time is concluded.

Mr. Kenny

Does the Taoiseach deny that using these State facilities for party political ends is a clear breach of the ethics code of conduct for office holders? Who will accept responsibility for this?

Mr. Durkan

That is a good question.

Mr. J. O’Keeffe

God help them.

Mr. Kenny

Will the Taoiseach order an immediate audit of what has gone on to date so we will not have a repetition of the matter? Does he accept that down the line, Fianna Fáil is utterly incapable of distinguishing the people's money from the party's money?

An Ceann Comhairle

I ask the Deputy to give way.

Mr. Kenny

Is it not a case that the taxpayers pay the price not only for the Government's failures but also for the Government's propaganda?

Mr. McGinley

Hear, hear.

Mr. D. Ahern

The Deputy is not so good at that himself.

Mr. Durkan

The Minister should take it easy.

An Ceann Comhairle

Allow the Taoiseach to reply without interruption.

Mr. D. Ahern

That died very quickly.

Mr. Allen

The Minister should not be nervous.

An Ceann Comhairle

I ask the Minister and the Deputy to allow the Taoiseach to reply without interruption.

Mr. Allen

Shake the trees, shake them well.

Mr. F. McGrath

It is the same old interruption. The Minister is starting to sound like the Steve Davis advertisement.

The Taoiseach

All the Fianna Fáil policy documents are printed through the Fianna Fáil headquarters or through printers nominated and paid for by Fianna Fáil.

Mr. Kenny

I am referring to the author.

An Ceann Comhairle

Allow the Taoiseach to continue please.

The Taoiseach

I do not believe any of our policy documents are authored by anybody other than people who would work for the party, or perhaps some advisers who work part time for the party outside their own work. As I said previously, the rules that apply under the Electoral Acts on how Ministers can use facilities, including constituency offices within Departments, have been clearly laid out by the Government secretariat. Every Minister and Minister of State has been given clear instructions on how such facilities must be used during the course of the campaign. Fianna Fáil's programmes and actions must be paid for by the party and cannot be paid for by the State.

Mr. Rabbitte

That is another brief the Minister, Deputy Martin, did not get.

Mr. Kenny

Who is responsible for this?

An Ceann Comhairle

I call Deputy Rabbitte.

Mr. J. O’Keeffe

A leopard does not change his spots.

Mr. Rabbitte

I join my colleagues in offering my condolences and those of my party to the relatives and friends of the Dunne family on the poignant tragedy that has been visited upon them and their community. In particular I offer condolences to Mrs. Mary Dunne, who lost a husband and two sons in recent weeks.

I refer the Taoiseach to today's Order Paper, in particular to the instruments laid before the House under the "Statutory" heading — I refer in particular to Nos. 27 and 28. Document No. 28, for example, is a policy direction issued on 14 July 2005 by the Minister for Health and Children to the HSE to begin a private hospital building programme on the grounds of public hospitals.

The reason these notices are on the Order Paper today is that a discovery was made in my office that the Minister had not complied with the Health Act 2004. Section 10 of that Act requires the Minister, when issuing a policy direction to the HSE, to ensure that within 21 days of issuing the direction, a copy of that direction is laid before both Houses of the Oireachtas. That appears in section 10 of the Act. The Minister was required to do that but she failed to do so. When I brought it to her attention last week, the response was an apology from the Department and a claim that it was an administrative oversight.

How is the biggest and most central plank in the Government's health services strategy, to build a number of super private clinics on the lands of public hospitals, an administrative oversight? Why did the Minister fail to comply with the law? We now know that if this is her central plank, she did not comply with the 2004 Act and she did not tell the HSE.

An Ceann Comhairle

The Deputy's time is concluded.

Mr. Rabbitte

She did not consult the chief executive of the HSE about this initiative. Why was a measure, enshrined in statute by the Houses of the Oireachtas, which requires the Minister to take a certain action, not implemented? Why is there a headlong rush, without any democratic mandate, to engage in a major shift in public policy towards an American style of for-profit health services, with the Minister failing to comply with the law?

An Ceann Comhairle

The Deputy's time is concluded.

Mr. Rabbitte

If there is anything more indicative of the incompetence of the Government, it is the change in direction from the health strategy that it campaigned on to provide 3,000 public hospital beds in 2002 to this American system, ideologically driven by the Minister's advisers. Does the Government, on the eve of the general election, still propose to proceed with these contracts? When will the contracts be signed? Are there tenders for inspection? Will we be provided with that information, or has the Government called this off, at least in deference to its backbenchers——

An Ceann Comhairle

Deputy, your time has concluded. I ask you to give way to the Taoiseach.

Mr. Rabbitte

——many of whom are as concerned about this matter as we are on this side of the House? One of his backbenchers even claims that one of his Ministers has assured him that it will not happen in any event and that "Harney", as he put it, will be thwarted. Is that the case?

The Taoiseach

An administrative oversight led to copies of two policy directions by the Minister for Health and Children in 2005 not being laid before the Houses of the Oireachtas as required by section 10(6) of the Health Act 2004. These related to a requirement for the Health Service Executive to prepare and submit a code of governance, which was issued on 18 February, and an issue related to co-location of private hospitals on public hospital sites issued on 14 July. Under section 10(1) of the Health Act, the Minister may issue written directions to the HSE for any purpose relating to that Act or any other enactment. Section 10(6) provides that a copy of such policy directions is to be laid before the Houses of the Oireachtas within 21 days.

The Department of Health and Children issued a press statement on 19 April indicating its regret concerning the administrative oversight and acknowledged the error in not having informed the Oireachtas in the manner prescribed and stating that it was taking immediate steps to rectify the situation by ensuring that copies of the policies directions issued would be laid before the Houses forthwith. The documents were laid before the Houses last Friday, 20 April.

On the second question Deputy Rabbitte asked, I would consider it just one of our initiatives in the health area. I do not consider it the main one. We have had many important initiatives, not least spending €500 million a year on the capital programme and employing 40,000 additional staff. The initiative is not based on a European, American or UK system. It is an initiative to transfer private activity from within the public hospital system to privately financed and managed hospitals to free up 1,000 additional beds for public patients and to try to improve the lot and the circumstances of public patients.

The new facilities, as I have said previously, will meet specific requirements, including the ability to admit private patients 24 hours a day, seven days a week from public hospitals — accident and emergency departments and GPs — and the capacity to treat all patients currently catered for in the public hospital, with joint clinical governance. There will be one accident and emergency entrance and service on the one campus.

On the information Deputy Rabbitte asked about, the Department of Health and Children has been informed by the HSE that invitation to tender documents were issued to the short list bidders on 19 April in regard to Waterford hospital, Cork University Hospital, Limerick Regional Hospital, Sligo General Hospital, Beaumont Hospital and St. James's Hospital. Invitations to tender for Connolly, Blanchardstown and Adelaide and Meath hospitals, incorporating the National Children's Hospital, Tallaght, will issue at a later date. Tenders are due to be submitted by 17 May. The HSE will then evaluate the tenders and select the successful bidders during the weeks after it. Following that there will be a stand-off period of two weeks, which must be done under procurement law, before an agreement can be signed. There will be a rigorous financial assessment of all the proposals at that stage. That will take account of value for money and the cost of any expenditure foregone. Obviously, it will take some weeks for that whole process to be followed.

Mr. Rabbitte

Does the Taoiseach agree that an admitted breach of the Act is not an administrative oversight? If the Act has been breached, surely what has been done is open to challenge by any person wishing to do so. The Taoiseach took up most of his reply by telling me what is in the Health Act. I know what is in the Health Act. The Minister did not know what was in the Act. The reason the documents were laid before the Houses on Friday was because of the questions we caused to be put to the Minister.

I do not know what other initiatives the Taoiseach is referring to when he says this is not the centrepiece of his new health strategy. I do not know whether he is referring to the 200,000 medical cards that were not delivered, the reform of the common contract which has not been delivered or the resolution of the nurses' dispute, which has not happened. Every which way this Government has looked on any initiative, it has come to grief and the sufferers are the public patients waiting for access to hospital care. They are in that position because of the two tier system and where the Taoiseach is heading now——

An Ceann Comhairle

Your time has concluded, Deputy.

Mr. Rabbitte

——will worsen that two tier system. The Taoiseach will permit the cherry-picking of the profitable procedures. He will turn the public health service into the poor relation. He is pushing ahead with that without any public mandate, knowing that the country is divided on it, knowing he has no support not just from this side of the House but from consultants and professionals working in the service, and the openly expressed reservations of the HSE.

Why is the Taoiseach pushing ahead in those circumstances or is he saying that no matter when he chooses to dissolve this Dáil, it is not possible between now and then to sign these contracts and that he will get out of it in his usual way by not taking a stand on the Progressive Democrats, by seeming to facilitate it and it will fall when this Dáil falls?

An Ceann Comhairle

Deputy, your time has concluded.

Mr. Rabbitte

There are people outside this House who want to know the answers because they know that we need those scarce public lands to provide the extra public hospital beds and the step-down and community care that will free up acute hospital beds and facilitate the smoother functioning of the accident and emergency service. The Taoiseach has no support for this initiative, not even in his own party, yet he tells us that he is pressing ahead and that the invitations to tender are gone out. Does he imply that they can be concluded before the general election because if he does, it is anti-democratic?

An Ceann Comhairle

Deputy, your time has concluded.

Mr. Rabbitte

The Taoiseach has no mandate to do it. He did not seek it in the last election.

An Ceann Comhairle

Deputy, I ask you to give way to the Taoiseach please.

Mr. Rabbitte

He did not seek it in the programme for Government. He campaigned on a health strategy to provide 3,000 public hospital beds which he failed to do.

The Taoiseach

I have given Deputy Rabbitte the timescale. Obviously, the timescale to complete the entire process will take several weeks after 17 May so the answer is that it cannot be concluded in the short term because that could run for quite some period. That does not take from the fact that I agree with the initiative. In my view, public hospitals should be for the benefit of public patients. Forty per cent of the activity of public hospitals should not be taken up by private systems, involving private operations and people in private beds, that are taking away the ability of public patients to get into hospitals. That is the current system.

Regarding co-located hospitals on some of the sites, we have about 50 hospitals in the State. We are talking about half a dozen sites. A number of the other hospitals already have co-located private hospitals such as St. Vincent's Hospital and the Mater hospital where they work in co-operation with each other. I have listened to the consultants in many of these hospitals where there is total agreement among the consultants and medical staff on the co-located hospitals in a range of these areas. An area where there might not be agreement is that some other private hospitals would rather private beds came out of the public hospitals and went to their private hospitals, which is a different matter. That might be an argument around——

Mr. Rabbitte

The Taoiseach knows as well as I do——

The Taoiseach

Please, Deputy Rabbitte. I listened carefully to you.

Mr. Rabbitte

I know you did.

An Ceann Comhairle

Deputy Rabbitte, allow the Taoiseach reply.

The Taoiseach

There is a clear difference between Deputy Rabbitte and me on this issue. I acknowledge that and I hope he does——

Mr. Rabbitte

I acknowledge it.

The Taoiseach

——but I do not accept that the current arrangement where the staff who work in a public hospital designate their beds and their times as private and public patients cannot get in. That is what happens.

Mr. Rabbitte

The Taoiseach has accepted it since 1922.

The Taoiseach

That is what happens, and it has grown. The Comptroller and Auditor General's report shows that it has grown.

Mr. Allen

The Taoiseach knew that before but he did nothing about it.

An Ceann Comhairle

The Taoiseach, without interruption.

The Taoiseach

I have no difficulty about the arrangements and what is happening in the transit units, the step-down beds and all those other units, but the issue Deputy Rabbitte and I have been arguing about week after week, an argument which is likely to continue year after year, is that he is happy with the arrangement.

Mr. Rabbitte

I hope not.

The Taoiseach

I ask the Deputy to permit me answer. I listened carefully to him.

Mr. Rabbitte

If we are to continue to fight about it, the Taoiseach is doomed.

An Ceann Comhairle

Allow the Taoiseach to continue.

The Taoiseach

The Deputy is interrupting because he does not want me to explain. He would like to turn this into a complicated issue when it is very simple. The public hospitals are losing a significant amount of their public beds to private patients, which benefits those who operate that system.

Mr. Rabbitte

Now the Taoiseach is defending it.

The Taoiseach

I want them to be designated for public patients. Ideologically, Deputy Rabbitte should be on my side on this but he has other reasons. When I discussed this with ICTU, it understood the issue. It had a problem with it several months ago. I do not see why Deputy Rabbitte continues to hold to a system that is inherently wrong in that a significant number of private beds are dominating public hospitals and creating the difficulties in accident and emergency units. That is what I believe.

Mr. J. O’Keeffe

Bertie the chameleon right until the end.

Caoimhghín Ó Caoláin

I join with other Members in extending my deepest sympathy to all those who have been bereaved by the tragedy in Monageer, County Wexford. The deaths of two young children and their mother and father represent an appalling tragedy. We offer our deepest condolences to all the bereaved, and especially the members of the Dunne and O'Brien families, on their great loss. We have to state very clearly that there are lessons to be learned from this tragedy and that it must result in action being taken. Each and every one of us must take on board the fact that people may be at risk in every community throughout the length and breadth of this State. Unless the required interventions are made, we will see tragic repeats of the events at Monageer.

Does the Taoiseach agree that a full and vigorous investigation is now needed and that such an investigation must incorporate a full examination of the role, responsibilities and responses of the Garda and the Health Service Executive? Does he acknowledge that the tragedy raises serious questions about the lack of resources for addressing mental health, suicide prevention and all the situations involving family and personal emergencies which can arise in our communities?

An Ceann Comhairle

The Deputy's time has concluded.

Caoimhghín Ó Caoláin

I am informed by people who have worked in the area of child protection that, because of an insufficiency of resources, they and their colleagues in social work teams have often been limited to fire-fighting responses when cases are referred to them. Is the Taoiseach aware that many professionals within social care teams who are doing support work under the aegis of the HSE have to prioritise on the basis of a weighed assessment of the cases that present and the queues for a response? Social workers are frequently in a position to respond urgently only where cases appear to be of an emergency nature. Unless trained professional assessments are properly available in every area, that apparent emergency requirement can easily be missed, understated or unnoticed, with often tragic results. What resources will the Taoiseach commit in terms of investing in mental health care and suicide prevention and to address the crises that can present for individuals and families——

An Ceann Comhairle

I ask the Deputy to give way to the Taoiseach.

Caoimhghín Ó Caoláin

——particularly in the type of case that has demonstrated such tragic consequences over the past several days?

The Taoiseach

Deputy Ó Caoláin asked me a number of questions and it will be impossible to answer all of them. As I said earlier, I offer my profound sympathies at this terrible time to the community and to those who are directly related to Adrian and Ciara Dunne.

We discussed the tragedy this morning and agreed in principle to set up an independent inquiry to examine the full circumstances of this case. The nature and terms of reference of that inquiry will be decided as soon as the facts of the events have been established. The Minister of State at the Office of the Minister for Children, Deputy Brian Lenihan, has sought a report from the Health Service Executive and a meeting will take place later today between the Office of the Minister and the HSE. In so far as the Garda Síochána is concerned, the Garda Commissioner has appointed a senior officer from outside the area to investigate the circumstances surrounding the tragedy from its point of view. We should allow both these investigations to be conducted and take care that we do not rush to judgment about the case with the luxury of hindsight and in the absence of all the information. I do not want to add to the grief of the families and the communities involved by going into the details of a situation on which the information is incomplete.

We know from the HSE's preliminary report that as late as midday on Friday a public health nurse visited the family for a routine development check-up of the children and had no concerns regarding the family. The HSE has also stated that it had no child protection concerns in respect of the family. I do not want to comment any further until the facts are fully known.

On the broader question asked by Deputy Ó Caoláin with regard to the appropriate level of child welfare generally, the HSE's primary aim is to provide child welfare and protection services within the family context, with the option of taking children into care considered as a last resort. The circumstances of each individual case are investigated with the aim of providing the necessary support and care at any given time. The question of appropriate levels of intervention in families where concerns about risks are expressed is extremely complex and difficult. Over the past year or two, we have debated that issue in this House in regard to other cases. In the case under discussion, the HSE has provided a counselling service.

Many other issues arise in regard to the wider question. These include issues that have arisen in other cases, in respect of which a working group is almost finished its report. There has been a large increase in staffing levels in these areas. Issues also arise with regard to out-of-hours services and in other areas which I may address later.

Caoimhghín Ó Caoláin

Does the Taoiseach not agree that social work of this kind cannot be organised and offered only on a nine-to-five basis? Is it not apparent from this and, indeed, the series of similar tragedies which have brought dark clouds over communities throughout this State that we need 24-seven cover throughout the areas of mental health and suicide prevention? This need has been expressed repeatedly. Does the Taoiseach agree that social work and family support teams must be fully resourced in terms of staffing and other facilities? What is he prepared to say this afternoon to confirm that he and this outgoing Government are going to do exactly that?

An Ceann Comhairle

The Deputy's time has concluded.

Caoimhghín Ó Caoláin

Over the past several months, I have heard from colleagues in various parts of the country. My colleague, the Wexford councillor, John Dwyer, and others have raised the issue of the absence of supports in their respective communities where cases such as this have arisen. They have highlighted it repeatedly, and that is on the record, yet here is another situation where the agencies entrusted to respond did not, on the evidence presented, act as they could and should have done.

An Ceann Comhairle

The Deputy's time is concluded.

Caoimhghín Ó Caoláin

There is a bounden duty to ensure that the agencies covered by the Children First guidelines, including the Garda Síochána, the Health Service Executive, schools and voluntary and youth work organisations, are resourced sufficiently to fulfil the role they must carry out. What is the Taoiseach prepared to do to ensure that this essential and very important area is properly resourced?

The Taoiseach

Last year there was a lengthy series of discussions between the HSE and the Office of the Minister for Children and the national working group to review the recommendations on the provision of out-of-hours child care services. The issue was examined on a national basis. The working group, which comprises the HSE, the Garda Síochána and Focus Ireland, reported on a comprehensive out-of-hours service for children and families. It has been developing a new model. Under the Child Care Act the Garda has a role and there are protocols. I understand that there is a protocol in force in Wexford but not every area has one. That model has been developed.

On the second issue of what we are doing, we all know that suicide is a very serious social problem. Reach Out, the national strategy for action on suicide prevention, has developed four levels of action in recent years: a general population approach, a targeted approach, responding to suicide and information research. The National Office for Suicide Prevention oversees implementation of that strategy, co-ordinates suicide prevention activities across the State and does very good work. Suicide prevention is an integral part of mental health and primary care services, and general practitioners play a key role in that. Effective action to prevent suicidal behaviour requires the involvement and collaboration not only of GPs, but also mental health professionals such as psychiatrists, psychologists, nurses and social workers. They are all involved with vulnerable people.

Last year, over €26 million was provided to develop mental health services in line with A Vision for Change, the report of the expert group on mental health policy. A further €25 million was allocated this year to continue that development and funding was allocated specifically for prevention initiatives and research. Money was also made available to develop a national training programme to complete the availability of self-harm services through accident and emergency departments and to implement the national positive mental health awareness programme. In light of the increased information in recent years, interim targets have been set for a reduction in the number of suicides across the State among people involved in self-harm programmes.

Such efforts do not always prevent problems and in this case, as in others, we must consider precisely what happened, if there were shortfalls, what were they and if something was missed, why was that the case? All that must be taken into account in an examination of the matter. I am pointing out what is being done and resources are being invested to make things happen. I agree with the Deputy on the out-of-hours issue. It is self-evident that these services should be provided not only on a 9 a.m. to 5 p.m. basis. That is an issue of negotiation in building a new model.