Leaders’ Questions

Before the last general election, the Minister for Health, Deputy Reilly, personally led a deeply cynical campaign on health promises and health issues. Across the length and breadth of the country, he promised that he and Fine Gael would ensure that no one lost any services and that a set of new, free services would be provided. Upon his appointment, the Minister announced the abolition of the management structures of the health services and that he was taking personal charge, but they have been leaderless and lacking governance ever since. He announced that waiting lists would reduce, prescriptions would be cheaper and free GP care for all was on the way. Since then, waiting lists have lengthened, prescriptions are just as expensive and the extension of free GP care is nowhere to be seen, despite being announced numerous times. He presented a false and dishonest budget to the House last year. He was warned repeatedly about this and was alerted about the crippling position regarding the health finances but did absolutely nothing except to repeat the mantra that front line services would be protected, while he already was implementing disproportionate and unfair cuts on the most vulnerable.

There is a deep sense of despair across the health sector in hospitals and community care. Members of the Government, as well as backbenchers, have been quoted left right and centre across the media as criticising the Minister, Deputy Reilly, and in particular his recent announcements in respect of cuts to those with disabilities. They have described those cuts in that announcement as being a catastrophe and regrettable. One Labour Party Minister was accused of having stated that "he should have had [I will translate - the liathróidí] to... announce the cuts himself, not hide behind one of his HSE lackeys". There is no precedent for a situation in which a Taoiseach praises a Minister for being brave in reversing cuts while the Minister simultaneously still is claiming the cuts never actually happened. The Minister of State, Deputy Shortall, at least has been honest about the failure by the Minister, Deputy Reilly, to manage the health budget by, for example, not negotiating a new agreement with the pharmaceutical sector.

I ask the Deputy to conclude the question please.

She even offered to chair those negotiations herself. However, she wrote to the Minister on 27 July asking for a report and stating she had no delegated statutory authority in respect of primary care and that she had not been consulted with regard to any matter pertaining to the budget.

I put it to the Taoiseach that the Minister of State, Deputy Shortall, was asked specifically a number of times whether she had confidence in the Minister, Deputy Reilly, on Newstalk, on "Morning Ireland" and in newsprint. The Minister for Social Protection, Deputy Burton, and the Minister of State at the Department of the Environment, Community and Local Government, Deputy Jan O'Sullivan, also were asked, in newsprint. All of them refused to state, very simply, "I have confidence in the Minister, Deputy James Reilly".

The Deputy is over time.

I ask the Taoiseach whether the Minister of State, Deputy Shortall, is correct in stating the Government's commitment to health reform genuinely is being questioned because of the Minister's lack of proactive engagement with the issues. Will the Taoiseach comment on reports that there will be numerous cutbacks in hospitals? Will he outline to the House how hospital deficits will be dealt with between now and December? Is he aware of planned closure of wards?

The Deputy is anticipating the motion of no confidence in the Minister, Deputy Reilly, tabled by his party. I understand Fianna Fáil had some kind of think-in in recent days because I seem to have heard this comment and statement from the Deputy. He said the Minister, Deputy Reilly, introduced a deeply cynical budget, which I reject. He made three points: that he committed to waiting lists being reduced, that prescriptions would be cheaper and that free GP care would be on the way. Those are the three charges he made and he has repeated them on numerous occasions.

It is reasonable to say that no one would be in a position to clear up the extent of the mess that was left behind after the Deputy and his colleagues removed themselves - or were removed by the people - from these benches. For his information, with regard to waiting list progress, for instance, there has been a reduction of 225 in the number of patients waiting on trolleys between January and September of this year when compared with the same period last year. That equates to 13,450 fewer patients waiting on trolleys. In addition, the number of adults having to wait more than 12 months for inpatient and day case surgery has reduced by 85% and the number waiting more than nine months has reduced by 63%. Those are not cynical allegations but are facts.

In respect of cheaper prescriptions, the legislation on reference pricing for drugs was introduced in the Seanad in July and will recommence there tomorrow.

It is a good job we still have it.

The Committee and Remaining Stages of the Health (Pricing and Supply of Medical Goods) Bill 2012 will be taken tomorrow. I assure Deputy Martin and everyone else that given the extent of legislation published and introduced into the House in the last period, this is a priority for this session and it starts again tomorrow.

In regard to free GP care, this is a little behind time, I admit. The legislation agenda is published today and this item is on the A list. The Government considered this and it is a priority. Work continues on that Bill to get it into the House as quickly as we can in order that free GP care can be extended to persons with prescribed illnesses. In addition, legislation to abolish restrictions on GPs wishing to become contractors under the General Medical Services, GMS, scheme is now in place.

Those are the three issues Deputy Martin raised and with which he bombarded his party at its think-in. Those are his answers.

Fundamentally I asked the Taoiseach two core questions. First, does the Minister of State, Deputy Shortall, have genuine confidence in the Minister, Deputy Reilly? That relates to very fractious correspondence between the two in July and May, when the Minister of State, Deputy Shortall, confirmed that despite seeking delegated authority on primary care, she had been frustrated time and again by the Minister, Deputy Reilly.

Furthermore, I did not say the Minister's budget was cynical. I said his election campaigning was cynical. I said his budget was false and dishonest. I agree with the Minister of State, Deputy Shortall. The Minister pencilled in €124 million for pharmaceuticals, another €140 for health insurance companies and €100 million for halving the agency staff.

The Deputy should get his facts right.

The Minister did not do a single thing in regard to any of those in the first eight months of this year, knowing full well that those targets were not realisable. That is why I charged that it was a false budget and that is what has put the health service into the crisis in which it finds itself this year in terms of finances.

The Taoiseach mentioned waiting lists. The cynical thing the Minister did on waiting lists was to change the targets and timelines. World benchmarks are three months and six months. He went out to nine months and 12 months-----

A question, please.

-----above which there are very few people, and then he quotes percentages. The key targets and objectives of the National Treatment Purchase Fund and its achievements over the years were dramatically reducing those on waiting lists for more than three months and six months. Since the Minister, Deputy Reilly, has come to office those waiting lists-----

There has been a 66% reduction.

-----have escalated and gone through the roof.

What about people with disabilities? What did the Government do for them?

(Interruptions).

It is not just those on this side of the House who have deep misgivings about how the Minister, Deputy Reilly, is acting. One Labour Minister is quoted as saying: "Several times I have tried to work with him on a number of things and he appears to be so partisan that if you're not one of his cronies, he doesn't want to know. I don't have that problem with any other Fine Gael Minister." Another Labour Minister said: "I would have some respect for him, but it was so [expletive deleted] cowardly, and for the amount of money involved, the heat we're all going to get from this is farcical."

Dúirt bean liom go ndúirt bean léi.

"The first I heard of the cuts was the HSE announcement," said the Minister of State, Deputy Sherlock. "Everyone else has managed to live with Croke Park and keep within budget. What is so special about James Reilly?" asked one senior figure. I ask the Taoiseach to read any newspaper in the past three weeks. The benches here deserted that man in droves in recent weeks and left him isolated because of his mismanagement of the emergency services. It is unprecedented that when Ministers are asked the simple question as to whether they have confidence in a fellow colleague, a senior Minister, Deputy Burton, and Ministers of State, Deputies Jan O'Sullivan and Shortall, could not articulate confidence in a senior colleague. That is the bottom line.

I call the Taoiseach.

The Taoiseach would be well advised not to be attacking this side of the House but to reflect on what is, unfortunately and regrettably, a common refrain across this House irrespective of party or constituency in terms of the management of the health service in 2012.

I call the Taoiseach.

A Deputy

Deputy Martin ran away.

Let the Taoiseach answer.

Do we have a new Ceann Comhairle now?

It is a bit rich for Deputy Martin to come into the House on the resumption of parliamentary business and talk about cynicism and misleading information and comments. Does he belong to a party that told the people they would have the cheapest bailout in history? Did I hear that from his party? Does the Deputy bear that brand on his forehead?

Fine Gael voted for it.

The cheapest bailout in history.

The new Minister for Health will not pay for one-----

(Interruptions).

I remind Deputy Healy-Rae that this is Leaders' Questions.

Deputy Martin never bothered-----

Do they have confidence?

Deputy Martin never bothered to look at what his Government created when it set up the original structure of the HSE. I want to tell him something now.

I want to tell the Taoiseach something about the files in the Taoiseach's office that were shredded. Is that a figment of his imagination, Lenin coming to Ireland in 1922?

Deputy Martin-----

The only reason the Deputy wants to take the course he is now taking is that he is terrified of the party on his right-hand side and his opportunism knows no bounds.

I think the Taoiseach is terrified of some of those on his left-hand side.

A Deputy

Who is coming second in the opinion polls?

The motion of no confidence takes place this evening and tomorrow. There will be a vote on it and he can be assured of the Minister and his Ministers of State speaking in his defence-----

Speaking in his defence?

-----and the Fine Gael and Labour parties supporting the work of the Minister for Health as he goes about his duties in so far as his remit is concerned.

I ask Deputy Martin to look at the consequence of what his Government created. He should go down to Kiltimagh in my county.

The Taoiseach without interruptions, please.

The Taoiseach promised them left, right and centre, and was caught out on tape.

He stood in the square.

He should go down and speak-----

He swore blind in here that he gave them no promise, but the tape appeared and he was recorded making a very definitive commitment.

Does the Deputy want to hear the truth?

-----to the proprietor of Home Care Medicals and walk into its warehouse. There is at least €3 million worth of equipment in that warehouse that has not been used for three years because of the bureaucracy that the Deputy's Government set up when the HSE was implemented in the first place.

The Taoiseach has been in government for a year and a half. Why does he not do something about it?

Each piece of that equipment has been decontaminated, packed and barcoded. However, simply because of the structure Deputy Martin's Government set up, people throughout the country have not been able to access beds, mattresses, hoists or wheelchairs.

Whom is the Taoiseach codding?

We had endless recurring purchasing within the structure of the HSE. The Deputy should go down and have a look at it. That will change because I informed the Minister, Deputy Reilly, of it last night.

That is not a big medical crisis.

Does Deputy Martin realise that a mattress for one of these beds costs €1,000-----

Does the Taoiseach realise that every penny spent on those mattresses is-----

(Interruptions).

The number of trolleys or mattresses will not resolve the problem.

Are we going to face more ward closures? Can the Taoiseach confirm that?

What was Fianna Fáil's plan?

-----of which there are 500? Does the Deputy realise that 147 people are currently waiting for one of these beds, which they could have in their own homes?

The Taoiseach is diverting from the core question.

In terms of the structure which Deputy Martin set up, he never bothered to look at the monster he created. That is all going to change now.

The Deputy raised three points.

He will raise another three later.

Waiting lists are down 22%, or 13,450 patients in the past 12 months. In respect of day surgery, the list is down 85% and the waiting list in respect of those waiting more than nine months is down by 63%. The legislation in respect of cheaper prescriptions is back before the Seanad tomorrow and will be taken here as quickly as possible.

Will there be ward closures?

The legislation will be taken in the Seanad tomorrow and will be taken in this House as quickly as possible.

Will there be ward closures?

The legislation in regard to GP care is a matter of priority.

Will there be ward closures?

Fianna Fáil can have its vote of confidence and will see the result.

Will there be ward closures?

I call Deputy Gerry Adams.

I have asked the Taoiseach five times if there will be ward closures.

Deputy Martin will have to ask him again.

Order, please. I have called Deputy Adams.

Táimid ar ais arís agus ba mhaith liom an Taoiseach a fháiltiú ar ais go dtí an Dáil. Tá súil agam go raibh sos maith aige thar an samhradh.

I am sure the Taoiseach will agree that the high point of the samhradh was the achievement of our Olympians and Paralympians. For me, the low point was the Government's plan to take entitlements from citizens with disabilities. Among other entitlements, the Government proposes to reduce personal assistant hours. Citizens with disabilities have rights. Those disabled citizens and carers who camped outside Tithe an Rialtais and picketed the Cabinet are to be commended. Is laochra iad agus daoine an-chróga atá ag déanamh obair an-tábhachtach agus iontach ar son a gclann agus a bpáistí agus ar son fear agus ban eile atá faoi chois ag an Rialtas.

These brave citizens forced the Government to do a U-turn. However, it still intends to proceed with cuts in home help hours and home care packages. The proposed reductions in agency staff and overtime will throw our hospitals into even greater crisis. Cuts to hospitals across this State, including in my own constituency, will result in more bed and ward closures, more citizens on trolleys and the undermining of essential services. This is nothing short of a scandal.

This Government has been in office for 18 months. I acknowledge it picked up a mess left by the people on my left. However, will the Taoiseach accept that following 18 months in office he and the Minister, Deputy Reilly, are presiding over a deep crisis in our health services? Does he not see that the cuts promised in the forthcoming budget will make this crisis even worse?

Tá fáilte roimh an Teachta Adams thar n-ais. Tá sé ag leanúint ar aghaidh leis an rud a bhí sé ag rá roimh an samhradh.

Tá súil agam go bhfeicfidh mé é Dé Domhnaigh seo chugainn freisin. B'fhéidir gur pointe an-ard a bheas ann. Deputy Adams will shortly have an opportunity to put on the record his party's constructive suggestions as to how we should deal with the fiscal challenge faced by our people and country not just for the next year, but beyond. I look forward to hearing constructive suggestions from him.

It is not with any pleasure that anybody stands up to say difficult choices must be made in the time ahead. The proposal to reduce personal assistant hours for those who work with members of their families or persons who are disabled was dealt with swiftly by the Minister, Deputy Reilly. I listened to the powerful words of Martin Naughton when he spoke outside Government Buildings. That matter was dealt with swiftly by the Minister, Deputy Reilly. The savings will come from cash management, travel and so on from within the administrative disability budget.

On the progress made over the past weekend at the Labour Relations Commission in respect of consultants and the number of other matters to be referred to the Labour Court, progress within the Croke Park agreement will lead to further savings, increased efficiency, greater throughput of patients and greater focus on patients' needs. That is an issue on which the Deputy will have an opportunity to have his say. Deputy Adams should not kid himself; while we have made steady progress through choppy economic waters, this country faces a series of challenges up ahead, which will not be easy for anybody. I do not underestimate the scale of that. In so far as health is concerned, the focus of the Minister for Health and the Government must be on the patient who deserves the best care and attention he or she can get.

Within the resources available, it is clear that many people are now doing so much more with less and that the impact that was assumed back in February when many people left the public service by choice was dealt with efficiently by front line staff in a whole range of areas.

We have work to do to change the structure of the health system to get to the point where the programme for Government can be implemented in terms of a single tier health system in which there is far greater focus and affect on the needs, requirements and facilities available to patients. Does Deputy Adams not understand that everybody in this House has the same philosophy in that regard? We may have differences of view about how one goes about this. The Minister, Deputy Reilly, dealt swiftly with the issue the Deputy raised.

I call Deputy Adams who has one minute for a supplementary question.

I am sure the Taoiseach will agree that the judgment of any society of any state is the protections it affords to its citizens, in particular the elderly, children, vulnerable people and people with disabilities.

Such as Jean McConville.

In particular, a State which calls itself a republic-----

Jean McConville.

-----where citizens have rights. The heckler is totally out of order. I will raise that matter later with the Leas-Cheann Comhairle.

This is Leaders' Questions.

The Deputy is totally out of order.

What did he say?

We are dealing with serious issues here. The Taoiseach in his response to me said that the Government is making difficult choices. The Government is making the wrong choices.

It is also making the wrong choices in regard to its election commitments. Most of what it is doing is totally in contradiction with what it promised. Does the Taoiseach recall the Leaders' debate in February 2011? The Tánaiste said that the first issue the Labour Party would address in government, in terms of equality and decent supports for people, would be that of disability. The Taoiseach agreed with that and said it would be an absolute priority. However, once the Fine Gael and Labour parties got into government they commenced cutting services to the elderly and those with disabilities while at the same time kowtowing to vested interests in the EU and the financial sector. Next month, on the Taoiseach's watch, unguaranteed bondholders will received another €1 billion. The Government is taking money from vulnerable front line sectors to put into unguaranteed bondholders.

The Taoiseach and Tánaiste have expressed confidence in the Minister, Deputy Reilly, which is hardly surprising.

A question please, Deputy.

Apart from the "Yes" men and women in the Labour and Fine Gael parties, he is on his own.

The Taoiseach is totally and absolutely on his own. Those who are working in and using the services do not share that confidence. With more cuts planned for December, will the Taoiseach not accept that it is long past time for the Minister, Deputy Reilly, to go? I know he is only implementing Government policy. Minister Reillys come and Minister Reillys go.

Deputy Adams will always be here.

It is important the Government gets back to implementing the mandate it was given and keeps the promises it made as opposed to doing the exact opposite. It should uphold the rights of citizens, in particular, those who are vulnerable.

I am interested in the Deputy's comment about protection of our citizens. I would like if he would elaborate on that sometime.

Absolutely. Does the Taoiseach want me to do it now? The Taoiseach asked me a question. Does he want me to do that now?

Deputy, the Taoiseach has the floor. One speaker at a time, please.

I hope that comment is not out of order. I would be interested to hear the Deputy elaborate on his comment.

Má shuíonn an Taoiseach síos, déanfaidh mé anois é. Is it better to do it now? Let us have a real debate now.

Certain citizens with disabilities had to camp outside-----

The Deputy will be aware that up to 2011 there were budget reductions of approximately €1.75 billion in the health services. The year 2012 saw further reductions of €0.75 billion. The fact is that €130 million in additional savings have to be achieved by the end of this year. Some €63 million or almost 50% will come from more focused cash and stock management initiatives, savings in medical equipment which are non-capital, items such as furniture, education, training, office expenses, travel, subsistence and advertising. Some €6 million in savings will come from the non-imbursement of certain non-essential products. Removing gluten free products will result in savings of about €3.6 million on an annual basis.

Shame on the Taoiseach. Coeliacs are----

All of those have no impact on patient care. That means that €60.5 million in savings will come from specific service related measures. Deputy Adams will have an opportunity shortly to spell out what he would do, not that he will ever have the chance. Agency and overtime reductions will account for savings of €35 million. The reduction in average length of stay is key to the delivery of agreed activity levels with fewer beds and therefore less staffing. There will be re-alignment of services in line with international best practice, redeployment of staff and revision of rostering practices. All of these have been referred to by the Minister, Deputy Reilly, and will be dealt with again in the debate on the motion of no confidence.

What about home help hours and home care packages?

The Minister has directed that every efficiency will be extracted prior to cutting any service. Patient safety is paramount. Care and sensitivity is to be applied in the case of Letterkenny, Naas and Our Lady of Lourdes Hospital, Drogheda where there are significant service challenges and a heavy dependency on overtime and agencies. The Deputy will be aware of the situation in so far as sick leave is concerned and so on. Inpatient discharges are 2.7% higher than the period last year and 8.1% above target. All of these can be dealt with during the course of the Private Members' motion.

The point is that the Minister, Deputy Reilly, and his Ministers of State follow Government policy and the mandate given to the Government was to sort out the public finances of the country, restore our economic sovereignty and give an opportunity for this country to provide jobs, employment and careers for our people and young people in particular and not to have them travel to other lands by necessity. That is a situation that is not easy to achieve. It is not with any great pleasure that any Minister has to refer to this as the challenging road ahead but as a women said to me last week, sometimes it is necessary to do hard things in the interests of the country. The impact of what has to be done in terms of patient care and patient facility is very close to the heart of Government and the heart of the Minister, Deputy Reilly, and will continue to be so.

I call Deputy Ross on behalf of the Technical Group.

No one would deny the difficulty that the Government has in making the cuts and balancing the budget in the current situation. The problem, as enunciated by two previous speakers, is that no adequate explanations have been given for the cuts being proposed. I refer not only to the cuts in the health service, which several speakers have addressed, but there seems to be a competing appetite for austerity among some of the Taoiseach's Ministers, competing on a daily basis to target sections of the population who cannot afford to pay for those cuts. I refer particularly to the recent decision - in respect of which the House deserves an explanation - not only to tax property owners but to tackle pensioners as though they are particularly well off.

Property tax is something the Taoiseach is asking middle Ireland to pay when middle Ireland has paid enough. Middle and lower income citizens will be asked to pay sums they cannot afford. Property tax will affect people from Dublin and lower income people disproportionately. Property tax will affect people in negative equity and in that case it will be, in effect, a tax on liabilities. It will also discriminate against people who have already paid large amounts of stamp duty. Middle Ireland cannot understand how it is being asked for more when many have not even paid the household charge. The time for a property tax to be introduced was in 2005 to 2007. I would like the Taoiseach to comment on this. That was the time when there was a-----

(Interruptions).

Was the Deputy advocating that in theSunday Independent?

Could Deputy Ross frame his question?

Yes. I am coming to the question.

(Interruptions).

The time for that was when the furnace was burning not now when the Taoiseach is trying to extract some oxygen from the ashes.

Why can the Taoiseach not go back to the troika which is demanding a property tax, and with whom it has agreement, and tell it about the report last week from the IMF? The Taoiseach will have read it. The IMF said that growth rates in this country will be down by almost half its projections for this year - from 0.7% to 0.4% and that growth rates next year will be down from 2.4% to 1.4%. What it is saying is that we cannot afford to pay, based on the assumptions set out in the bailout. Could the Taoiseach not go back to the troika and tell it that by the IMF's own criterion we cannot impose these sorts of taxes on middle Ireland because it will not be able to pay them?

I have often given the Deputy credit for his extensive knowledge of-----

It is no laughing matter.

-----the broad world of economics but he said that the time to introduce a property tax was in 2005 or 2007. The Deputy realises that if a property tax was introduced in those years with house values the way they were, the level of such a tax would have been extraordinary when people were paying €1 million for end of terrace houses and multiples of millions for houses in the greater Dublin area and places around the country.

You did not think of that one. It depends on how much one charges.

Deputy Ross should be clear on this. The following is the situation in so far as a property tax is concerned. A property tax will be introduced.

A family home tax.

The Government made a decision that the Revenue Commissioners would design the process and the mechanics of how that would apply. A property tax will apply from 1 July next year. The Minister for Finance ruled out implementing a property tax in the way and at the level that the IMF recently reported, as 0.5% of market value.

It has not been brought to Government yet.

The situation is that anything outside that is entirely speculative. The Government has not considered the Thornhill report in detail, it will do so collectively and will make a decision on that.

It takes the Minister three months.

When I joined the county council many years ago, people paid for water and refuse services and they paid rates. Surely in Deputy Ross's constituency in Dublin, he recognises that year after year commercial ratepayers were completely squeezed and have come to the point where many of them, with the downturn in retail activity, have not been able to draw anything from their business for quite some time. The requirement here is to broaden the tax base by having an equitable and affordable property tax. That is the question that the Government will decide on in due course.

So you are not the one who said it was a vampire tax.

Order please. I have called Deputy Shane Ross.

(Interruptions).

Could we have order please?

I thank the Taoiseach for his reply. The Taoiseach said that any comment on this was speculative. Does that include his own statement that it would raise €500 million, which he is on record as saying?

Which he has not decided.

Does that include the fact that the Minister for Finance has already said that it would not be 0.5%?

Which he has not decided.

Does that include other statements from members of the Government about it coming in? What is happening here is a softening up process.

The Government is leaking stuff to the press left, right and centre. It is appearing all the time. It is making statements on the record as well-----

A Deputy

We would not dream of it.

-----to soften people up and then saying-----

(Interruptions).

-----that this is speculative. What is happening here is that the middle classes and the lower paid are being prepared for another blow which they cannot pay. Would the Taoiseach therefore give some comfort to those in negative equity that they will not have to pay property tax? Will he give some comfort to house owners in Dublin that they will not have to pay a disproportionate amount based on the value of their houses? Will he give some comfort to those on low incomes that they will not have to pay the same amount as those on higher incomes, and will he give some comfort to any other person in a vulnerable position who will not be able to pay that tax?

What the Deputy is engaged in is a box ticking exercise to rule out or rule in certain references to the property tax so that he can narrow the field, as it were.

Kicking the can down the road.

I will repeat for the Deputy the concrete decisions that have been made. There will be a property tax. The Revenue Commissioners have been asked to design the mechanics of that scheme. It will apply from 1 July next year.

In respect of people being frightened, the IMF report which was published was ruled out by the Minister for Finance in so far as the implementation of its reference to a property tax as 0.5% was concerned. Anything else outside those concrete decisions is speculative. I have seen one newspaper indicate that a decision was made that the rate would be at a certain level. All of these things are speculative. The one that is ruled out in terms of rate of tax is 0.5% of market value.

Let us be clear on this. The Government will consider the recommendations from the Minister in respect of the Thornhill report in due course and Government will reflect on that very carefully. We would like that the property tax to be introduced would be as fair and as affordable as possible.

That concludes Leaders' Questions. Does the Taoiseach wish to make a statement?

Will I do it now or on the Order of Business?

Is the House agreed that it be made now? Agreed.