Confidence in the Minister for Health: Motion (Resumed) [Private Members]

The following motion was moved by Deputy Billy Kelleher on Tuesday, 18 September 2012:
That Dáil Éireann has no confidence in the Minister for Health, Deputy James Reilly, because of his inability to deliver on his budget commitments which were based on false and misleading targets in many areas that were never achievable or implementable due to his lack of governance, resulting in more chaos across the health service which will directly impact on patients because of more front line services being cut, extra bed closures, and more cuts to social support services to the disabled and elderly.
Debate resumed on amendment No. 2:
To delete all words after “Dáil Éireann” and substitute the following:
"commends the Minister for Health, Deputy James Reilly, on the progress to date on the reform of our health services and for the effective manner in which he is managing resources in a difficult budgetary and economic environment, placing the concerns of patients at the centre of the healthcare system;
endorses the specific measures that the Minister has taken to improve the performance of the service delivery system and to strengthen the overall governance and accountability of the system; and
supports the Minister in his determination to move towards a health system that provides access based on need rather than income, underpinned by a strengthened primary care sector, a restructured hospital sector and a more transparent ‘money follows the patient’ system of funding that will be supported ultimately by universal health insurance."

- (Minister for Health).

The first speaker is Deputy Healy, who I understand is taking two of the ten minutes available to the Technical Group.

I wish to share time with Deputies Catherine Murphy, John Halligan, Joan Collins and Luke 'Ming' Flanagan.

I support the motion of no confidence in the Minister for Health, Deputy Reilly, before the House tonight. It gives me no pleasure to be obliged to so do. As far as I am concerned, each Minister and the Government collectively are in the dock in respect of their handling of the economy and the nation since their election. All the aforementioned Ministers and the Government are here under false pretences. They were elected on a programme of commitments, which included burning the bondholders, not giving another cent for the banks and the protection of the vulnerable. Each Minister and the Government collectively have reneged on all those commitments and I reiterate they are here under false pretences.

However, the Minister for Health has a specific case to answer. I believe the Minister has a conflict of interest because he is involved in the private nursing home business while at the same time, he is presiding over the Health Service Executive and a health service that is closing public long-stay beds nationwide. I believe this is a serious position and constitutes a conflict of interest for the Minister. It certainly is one reason I support this motion this evening. In addition, the recent cuts announced by the HSE and approved by the Minister can only be described as a descent into barbarism. The most vulnerable, the sickest, the elderly and people with disabilities were deliberately and knowingly targeted and this runs counter to the election commitment that the most vulnerable would be looked after and protected. I support this motion.

While I had no expectation that the reforms in the health service would be delivered overnight, I had an expectation that by now the direction would be shaped, a vision outlined and a credible plan of action put in place. Where I agree with Fianna Fáil's motion of no confidence is that the budget put forward was completely unrealistic from the outset. For example, the notion that agency staff could have been dispensed with at a time when an unfocused early retirement scheme had just kicked in was completely unrealistic and it was predictable that problems would arise. However, I believe the Government is justified in its criticisms of the proposers who, after all, created so many of the problems evident in the health services today. Unfortunately, I was not in any way surprised to see disabled people taking to the streets in protest when cruel cuts were targeted at them in particular. These cuts would have undermined them and would have taken away their hard-won independence. Not only was this measure cruel, but it is not even cost-efficient when measured against the institutional care model it would have been necessary to use as a substitute. Although the Government committed to protect the vulnerable, it is glaringly obvious it has not done and is not doing so. Unfortunately, this is just one example of the kind of front line cuts evident to all Members. Baby clinics have been dispensed with, dental oversight in primary schools has been cancelled and home help hours have been specifically curtailed, on foot of which highly vulnerable and often elderly people have been affected. These are merely a sample of what Members encounter routinely.

I also had expected to see some major institutional changes at the HSE. It appears that what is proposed is yet another top layer of management with little of the kind of reform desired or needed by citizens and so many of those working within the system at all levels below management. A single look at the HSE's website reveals the chaotic structure behind it, which only is intelligible to those who work within the system and certainly is not citizen-friendly. People have a right to real reform, not a bookkeeping exercise. However, the latter is what they are getting and this is what must change.

When the Minister was in opposition, he outlined a detailed plan to reform every aspect of the health system and how it delivered care to patients. Moreover, he decried previous health policies for what he called their slash and burn techniques and, in his own words, promised "the money would follow the patient". I accept the Minister's challenge was formidable. However, I have challenged him previously and do so again to visit my constituency of Waterford to ask the patients in Waterford Regional Hospital how long they have been waiting on trolleys. He should ask them how long they have been waiting to see a specialist or how many times they have had procedures cancelled. He should speak to the surgeons who cannot treat their patients because of the lack of availability of a bed, an anaesthetist or an intensive care unit nurse. I have spoken to all these people.

I am uncomfortable with Fianna Fáil calling for a vote of no confidence in the Minister, given that party supported a person who in my estimation was one of the worst Ministers for Health we are likely ever to see in the history of the State. The vote of no confidence in the Minister in essence is coming from my constituents and not so much from me. It is because of the 18,925 people who are on outpatient waiting lists, the 5,847 people who have been waiting for more than a year and for orthopaedic outpatients, some of whom have been waiting for four years.

Finally, I refer to a case with which I am dealing involving a man who worked in the health service for 20 years and who incurred a severe back injury. He has a medical card and seeks the insertion of a device known as a Wallis spacer. The Minister is well aware of this and I sent a letter to him in this regard. This person was told that even though he is entitled to the device and has a medical card, the hospital does not have €3,900 to pay for the aforementioned procedure and consequently, he is walking around half-crippled. The Minister should read the letter I sent to his Department. Consequently, I do not speak primarily for myself but for the many constituents who visit my offices throughout the constituency and who themselves state they have no confidence in the Minister. I like the Minister as a person and have spoken to him a number of times. There is nothing personal in this and I acknowledge the Minister has dealt with me quite competently. I regret being obliged to support this motion and am uncomfortable in so doing because Fianna Fáil has tabled it but I must stand by what my constituents tell me to do.

In supporting the motion of no confidence in the Minister, Deputy Reilly, I will make use of an example. Two weeks ago, one of my constituents contacted me and his experience really exposed the problems that exist within the agency and which the Government promised it would try to fix. It is a simple problem that should not be there. My constituent, Mr. Dermot Walsh, who is a well-known disability rights advocate and has no difficulty with my use of his name and who I contacted beforehand, uses his wheelchair to get to work. However, he has been unable to so do in recent weeks because of the bureaucratic incompetence of the HSE. The system for carrying out repairs to wheelchairs has changed in that heretofore, he was able to contact his engineer and have the maintenance to his wheelchair dealt with regularly.

This arrangement was recently changed by the HSE and all repairs are now done in house. One of the wheels fell off his wheelchair and he needed to get it fixed very quickly. However, under the new arrangement his wheelchair had to go into the health clinic. That wheelchair was assessed in his absence and without consultation with him. This flies in the face of the so-called person-centred consultation. As a consequence, it is unsafe and he has been waiting for more than four weeks for his wheelchair to be fixed. The assessment proposed a number of changes to be made but he does not want them as they are not needed and he is still out of work. While I am not blaming the Minister for that, his actions in cuts in home help, home-care, PAs etc. fit very well into the bureaucratic penny-pinching approach to health care and the Minister should go.

Mr. John Dolan, chief executive of the Disability Federation of Ireland, has said that despite promises in the programme for Government to enhance the quality of life for people with disabilities, the Government was going in the other direction. All Government members should go back to the people to seek a mandate for what they are doing at the moment.

When one applies for a job in the normal world, one is supposed to tell the truth about what one will do, how hard one will work and what one's qualifications are. In advance of the general election in an open letter to the people of Roscommon, the person who is now Minister for Health, Deputy Reilly, said the following:

I would like to confirm that Fine Gael undertakes, in accordance with the Fine Gael Policy on Local Hospitals, to retain the Emergency, Surgical, Medical and other health services at Roscommon Hospital which are present on the formation of the 31st Dáil. [It got even better, though.] Furthermore, in the event of the A&E being downgraded, we are committed to reinstating a 24/7 service, where feasible.

In a normal job when one tells a porky, one loses one's job if found out. For that reason alone - there are many other reasons - the Minister should resign.

When is the Deputy going?

I support the motion. The motion of no confidence also presents the perfect opportunity for Deputy Feighan to show that the 9,000-plus people who voted for him at the last general election did not completely waste their time.

(Interruptions).

With respect, may I have the protection of the Chair?

Order, please. Let the speaker finish as he has only a few seconds left.

(Interruptions).

Order, please. As the Deputy has only a few seconds remaining, I ask him to finish up.

No problem - I thank you very much.

A Deputy

The Deputy can give it but cannot take it.

The reality is people should tell the truth when they go before the electorate.

That is very important. They should stand by the people - they pay their wages.

I ask for order from both sides of the House, particularly the Government side, when other speakers are speaking.

On 9 March 2011, I nominated Dr. James Reilly as Minister for Health. I did so, not because he has decades of experience as a GP or because he developed a radical policy to create a patient-centred health system, but because he has a passionate commitment to creating a health service that puts the patient first.

The Government received a mandate from the people to create a universal, single-tier health service, which guarantees access to medical care based on need, not income. I and my colleagues around the Cabinet table are acutely aware of the challenge that faces us in terms of health reform. It will not be done overnight. It is a complex and major undertaking that requires careful planning and sequencing. It will take time, patience, diligence and courage. What the Minister and we as a Government inherited was chaotic, unsustainable and unacceptable.

Against this backdrop, the Minister for Health faces another challenge which is to maintain services and ensure patient safety while having to achieve savings of more than €2 billion and to reduce staff numbers by 6,000 over the past two years. Some might see this challenge in itself as an excuse to stand still and accept the status quo as the last Administration did. However, despite the difficult financial environment, the Government's health reform programme is on track and patients are experiencing real change in our hospitals.

Between January and September this year, there has been a 22% reduction in the number of patients waiting on trolleys, compared with the same period last year. This equates to 13,450 fewer patients waiting on trolleys. The number of adults having to wait more than 12 months for inpatient and day-case surgery has reduced by 85%, and consultants will now see, treat and discharge patients 24 hours a day and seven days a week, saving the State hundreds of millions of euro - an issue the last Administration was afraid to tackle.

Since the Government came into office, patients are being seen and treated in a more timely fashion. This is the daily on-the-ground impact of the reforms being implemented in our hospitals by the Minister, Deputy Reilly. The establishment of the special delivery unit last year has helped to reduce the numbers on trolleys significantly. This has been done largely through better organisation and management.

With regards to the structural reform of the health system, the building blocks are being laid and the steps ahead are clearly indicated. In July, the Minister published the Health Service Executive (Governance) Bill 2012 which provides for the abolition of the HSE board and the establishment of a directorate to be the new governing body for the HSE in place of the board. Government approval has been given to proceed with the establishment of hospital groups ahead of the creation of hospital trusts and intensive work continues on this. The Minister is examining the small hospital framework in the context of the overall reorganisation of the health services with the aim of ensuring a viable future for our smaller hospitals. His report and proposals will be published shortly.

The programme for Government is committed to introducing universal free GP care within our first term of office. Work is progressing on the preparation of legislation this Dáil term to allow for the extension of free GP care to persons with prescribed illnesses. The legislation to abolish restrictions on GPs wishing to become contractors under the GMS is already in place. The programme of work for primary care led by the Minister of State, Deputy Shortall, will fundamentally change for the better the level of service available to patients.

The progress to date underlines the Government's commitment to health service reform and the implementation of universal health insurance. The ring-fencing of finance for mental health being led by the Minister of State, Deputy Kathleen Lynch, signifies an end to this critical area being the forgotten element of health strategy. These changes are occurring as part of a very certain process to put an end to the two-tier health system.

The key objective of the Minister, Deputy Reilly, is to make these changes in order to put the interests of the patient at the heart of the health services. It is not the needs of the system that should dictate how patients are treated, rather it is the needs of patients which should dictate how the system is designed. That design work is under way and will continue.

Let me assure the House that the Minister, Deputy Reilly, did not engage in a deeply cynical campaign before the election. He articulated a health reform programme that he is passionately committed to implementing. It was not the Minister, Deputy Reilly, who promised to end waiting lists within two years. It was not the Minister, Deputy Reilly who promised improved accident and emergency services by reducing waiting times or having senior doctors available at all times. I have every confidence in the ability and determination of the Minister to see through to fruition the reforms with which he has been tasked. He is a man who came into politics for the right reasons - to change the Irish health service for the better. I have every confidence in his ability to deliver on the mandate and responsibility given to him.

The motion before us is one of the most cynical examples of political gamesmanship seen in this House. Fianna Fáil accuses the Government of failing to meet its budget commitments in the health service because it claims this will impact on patients and services to disabled people and the elderly. One must wonder whether Fianna Fáil Members were thinking of these same people when they sabotaged our economy or were they too busy partying on to heed the warning signals about our overheated property market, reluctant to restrain the boardroom excesses of their golfing buddies in the bank? They were more interested in keeping the till ringing with stamp duty than in sustainability for the economy. Were they thinking about the people when they tied our fate to that of a bank that was already bust and negotiated a bad deal which they then said could not be renegotiated?

When Fianna Fáil left office in February last year it left behind it a budget deficit of €22.4 billion, 444,000 people unemployed, a banking collapse that ended up costing the taxpayer €64 billion and our economic sovereignty surrendered because the country could no longer pay its bills. One can only marvel at the sheer neck of the 19 Fianna Fáil men on the benches opposite.

Deputies

Hear, hear.

To come into this House and cry crocodile tears for older people and people with disabilities when it is was they and they alone who put a catastrophic hole in the national finances is a cynical move indeed.

The adjustments to the budget in the health service over the past number of years have been difficult. Since 2010, €1.75 billion has been removed from the health budget and services are being delivered with 6,000 fewer staff. Yet, this Government and its Minister for Health, Deputy Reilly, have demonstrated that it is still possible to make progress, in some cases more progress than was made by the previous Government during the largest expansion on health spending in the history of the State. Let us take the number of people waiting for care on hospital trolleys. Last January 12 months, Fianna Fáil presided over an all-time high of 569 patients on trolleys. This September that figure had decreased by 75%. Surgical waiting list numbers are down 7% and the number of people waiting 12 months or more is down 85%. This was not achieved by accident but by design, by the putting in place of a new special delivery unit tasked with changing how hospitals manage their patient flows.

This Government and its Minister for Health have not shied away from tackling vested interests in the health service, including addressing the cost of drugs, increasing competition between general practitioners and only last week striking a deal to get more flexibility from hospital consultants and reducing pay for new recruits.

Deputies

Hear, hear.

Throughout all of this we are getting on with fundamental reform of the health service-----

The Tánaiste has two minutes remaining.

-----reforms that stem from a core belief that every citizen in this country has a right to be treated when sick regardless of income.

Fianna Fáil has never believed in this simple principle. It defended the two-tier health system to its last breath. It now says that because nothing changed under its leadership then nothing can ever change. This is the first Government in the history of the State that is committed to a fair, single-tier health system underpinned by universal health insurance. It will not happen over night but we are taking the first steps, changing how we deliver services to get better value for money. The linchpin of these reforms is primary care and delivering more care in the community rather than in accident and emergency departments.

Together with the Minister, Deputy Reilly, my party colleagues, the Ministers of State, Deputy Róisín Shortall and Deputy Kathleen Lynch, have been working extensively on progressing these reforms. Under the first phase of free GP care for people-----

The Tánaiste has been away too long.

They are all best friends.

-----with certain chronic illnesses some 300 key primary care staff will be in place by the end of this year. I commend the two Ministers of State on their work, in particular the Minister of State, Deputy Kathleen Lynch, for her work in the area of disability and for progressing the development of mental health care in the community, something that has been neglected for far too long.

Where was the Tánaiste when the disabled people were outside the Taoiseach's office?

Let us be clear, this Government-----

(Interruptions).

-----and its Minister for Health are dealing with the catastrophic mess left behind by Fianna Fáil.

Fianna Fáil is in no position to take this Government to task over the work it has been doing reforming the health service and making progress. We are doing this as fairly as possible. We have protected and will continue to protect those who are most dependent on health and care services. We do not always get it right and we are not afraid when we do not get it right to admit our mistakes and correct our direction.

Deputies

Hear, hear.

Most of all, we respect the people who elected us to fix this broken country. We have been doing that for the past 18 months and will continue with that job, which will continue with reform of the health service led by the Minister, Deputy James Reilly and Ministers of State, Deputies Shortall and Lynch.

Deputies

Hear, hear.

Where is the Leader of Fianna Fáil?

Order, please. I now call the Minister for Finance, Deputy Noonan, who has four minutes.

Prior to the election in February of last year Fianna Fáil-led Governments had controlled the Department of Health for 14 years in a row. The Ministers for health were the former leader of the Progressive Democrats, Mary Harney, former Taoiseach, Brian Cowen and current leader of Fianna Fáil, the architect of the Health Service Executive, Deputy Micheál Martin. Fianna Fáil has some cheek tabling this motion. When in office it had control of the Department of Health for 14 years.

The Minister held that portfolio himself once.

He did not cover himself in glory either.

It was not mismanaged by neophytes, rather it was run by some of Fianna Fáil's leading lights together with former Deputy Mary Harney. Fianna Fáil has tabled this motion of no confidence in the Minister for Health, Deputy James Reilly having left behind a shambles after 14 years in office.

In 1997 there were 65,000 people working in the health services. When Fianna Fáil left office the number of staff in the health services was almost 120,000 when one includes agency staff. In 1997, the budget was just over €2 billion. When Fianna Fáil left office it was almost €14 billion. Despite all the extra personnel and additional budget the service was worse in 2011 than it was in 1997.

Fianna Fáil is now blaming the Minister, Deputy Reilly, for trying to sort it out.

Put that in your pipe.

In just 18 months, Minister Reilly has a considerable record of achievement with a more than 20% reduction year on year in the number of patients on trolleys, a reduction from an all-time high of 569 patients on 5 January 2011 to 139 on 7 September 2012, which is a 75% reduction; overall surgical waiting list numbers have decreased by 7% while the number of people waiting over 12 months has decreased by 85%; those waiting over nine months by 63% and those waiting over three months by 66%. The Health (Pricing and Supply of Medical Goods) Bill 2012 has been published; the restrictions on GPs wishing to become contractors under the GMS have been abolished; a programme for the development of 20 primary care centres using public private partnerships has been established and the development of chronic disease management programmes, in particular the management of diabetes, is at an advanced stage. It is particularly noteworthy that these significant reforms have been achieved despite the 6,000 reduction in staff as referred to by the Tánaiste and reductions in budget of €1.75 billion. The Minister's most notable achievement is the new arrangements agreed in negotiations last week with hospital consultants. Fianna Fáil's political timing is very poor in terms of it having tabled a motion of no confidence in the Minister, Deputy Reilly, at a time when he was negotiating one of the major reforms in the public service, namely, the new agreement with the consultants.

The researchers should be sacked.

There will be new rostering arrangements for consultants and more flexible working arrangements to cover 24/7 services and lower levels of pay for new entrants to the consultant grades. These reforms are essential to generate additional savings under the existing agreements with radiologists and other grades.

Fianna Fáil should pack up its tents, apologise to the Minister, move the adjournment of the House and we can all go home.

Deputies

Hear, hear.

Where is Micheál?

(Interruptions).

Order, please. The next speaker is Minister of State, Deputy Róisín Shortall, who has four minutes. I ask Members for order while the Minister of State is speaking.

This Government faces a huge challenge, to manage and reform the health service when the health budget is being reduced. As part of that process the key question that arises for us all is who will bear the burden of the cuts. For example, do we increase prescription charges for medical card patients or reduce the drugs bill? Do we cut public health nurses or collect money owed by insurance companies? Do we cut home help services or impose a cap on consultants' pay? Our priority must be to protect front line services. We cannot cut our way out of problems. We must reform and that reform must happen quickly. Unless there is substantial reform there will be cuts and the poor will be hardest hit. Reform means reducing costs and changing the model of care to switch the focus from acute hospitals to community and primary care.

This will ensure early diagnosis, much better health outcomes and much better value for money. That is why the programme for Government prioritises primary care in the term of this Government. To deliver on the programme we need fully staffed primary care teams working from modern primary care centres. That is why we must recruit the 300 front line primary care staff to areas of greatest need, staff such as public health nurses, speech and language therapists and occupational therapists, and for which staff funding was provided this year. Thousands of people, both children and adults, are on waiting lists for these services. It is time we started the recruitment.

Decisions on where staff are allocated and where primary care centres are located must be transparent and objective based on health need and no other consideration. Primary care centres, just like schools, are essential public infrastructure and should be provided on the same basis. The programme for Government commits to extending free GP care to all in this Government's term. We know that fees stop people attending their GPs so they eventually need more expensive hospital care. Private fees for GPs are just 2% of national health spending but their removal unlocks the potential for major reforms. The lack of priority afforded to producing the free GP care legislation has been very disappointing. Allocated funding must be restored to start this key initiative this year. We must also have a clear roadmap that charts the way forward and ends the uncertainty about the future.

These are just some of the questions that need to be resolved. Are we going to reform and strengthen our public health service or are we going to privatise large parts of it? How do we ensure access and equity in the health service? What model of universal health insurance best suits the situation here in Ireland? Should it be a commercial insurance model or a social insurance model?

There are many questions but no answers.

What will replace the HSE and how best can we control costs?

Reform of health care is never straightforward, as we all know. Decisions taken by the Government over the next few months will determine the shape of the future health care system. That will determine the shape of the system for years to come. We have to get it right. Reforms must be made in the best interests of patients.

That is hardly a ringing endorsement of the Minister, Deputy Reilly.

Where is the Deputy's leader?

I want to speak on this motion, both as a politician and as a medical doctor, in support of my ministerial colleague, Deputy James Reilly.

The health Ministry is one of the most challenging in any Government and even more so at a time when the need for reform is so great and availability of funds so limited. Deputy James Reilly sought to become Minister for Health. He wanted the job, unlike many others who either viewed it as an Angola or, as in the case of Deputy Martin, the architect of the HSE, navigated their way through it by establishing an apparently never-ending number of expert groups and consultative fora to develop grand plans while failing to deliver any of the necessary changes.

This is a Minister and a Government determined to deliver on the clear commitment contained in the programme for Government to develop a universal single-tier health service which guarantees access to medical care based on need, not income. It is easy to point to the failings of the health service and we all know there are many, but we must also acknowledge the significant progress which has been made in the short 18 months since Deputy James Reilly became Minister.

Failings in the health service understandably give rise to public concern, but we need to have a balanced debate, one which acknowledges the progress made as well as the fact that there is so much more to be done. We also need to acknowledge that reform and improvement takes time. Under the previous Government, success was measured by the ever-growing size of the health budget rather than by what was achieved. Ministers congratulated themselves on spending more money every year and judged themselves on the size of their budgets. The Minister, Deputy Reilly, works in a country that does not resemble the country at that time and, alongside the Ministers of State, Deputy Kathleen Lynch and Deputy Shortall, he has to reform the health service while reducing the budget. Collectively, they probably have the toughest job in government and they deserve our support and confidence.

Despite the fact the Minister, Deputy Reilly, has had to operate within a budget which has been reduced by €1.75 billion, which is almost my entire budget for the past two years, and that he has had to operate with 6,700 fewer staff, the system has not only been maintained in some areas, it has even been improved. More people are being treated in our hospitals. There has been a 7% increase in patient discharges. More people have access to free health care than before. Some 125,000 additional medical cards have been issued and now 1.8 million people in the State have a medical card, which is more than ever in the history of the State. That is a real achievement at a time of such austerity. Patients are being treated more quickly. We have 20% fewer people on trolleys than this time last year. No one is waiting for surgery longer than a year and we are moving towards a nine-month deadline for inpatient treatment. On the day on which the children's protection amendment was published, we also have 800 fewer children on a waiting list than we did at the time of the general election. These are the facts. Of course, a lot more needs to be done and the Minister has set in train an ambitious series of reforms which will deliver further improvements.

Over the course of the next five years the reformed health service will put patients first and will put their needs at the centre of the system. I know that for patients and their families such improvements cannot come soon enough. We have all had enough of grandiose promises with few significant improvements from Fianna Fáil in government. We now have a Minister with the knowledge, the vision and the determination to deliver ongoing improvements like he has in recent days. There will be lots of difficulties along the way and special interest groups in health are very good at analysing problems and outlining how changes can be brought about, but too often they are unwilling to play their part in the delivery of such change.

The Minister and the Government will deliver reform and will endure no lectures from those who had 14 years at a time of unprecedented wealth to get it right but instead left us with a dysfunctional health system and devastated public finances. We will not take lectures either from those alongside them on the Opposition benches whose only contribution to health care on this island was to fill our hospitals with the victims of their campaign of violence. Indeed many of these people are still alive today and still have ongoing health care and disability related needs.

For all of us in the Government and all of us on the Government benches, change in all areas is not coming as quickly as we would like, and delivering change and driving it is not as easy as it may have appeared when we were in opposition, but the Minister, Deputy Reilly, is making real progress and is making real change happen. He deserves our confidence and our support.

Last week my constituency colleague wrote a personal letter to the Roscommon People calling me a traitor and asking me to resign. I have no interest in resigning and I will not resign. I will work within the Government with the excellent Minister, Deputy Reilly, the Minister of State, Deputy Shortall, the Minister of State, Deputy Kathleen Lynch, the Labour Party and the Fine Gael Party to deliver a real health service in this country, and that is what we are going to do.

Deputy 'Ming' Flanagan went to a meeting a year ago at which he was told by the Health Information and Quality Authority, HIQA, and the HSE why Roscommon County Hospital accident and emergency department could not survive, which was because fewer than 30 people a day were using it. His mature comment was that he told a startled health official to go out and get a rope and hang himself. I have stayed in government and I have been at a meeting every week in Roscommon County Hospital. Patient safety will be much better in that hospital and throughout this country because of this Government. I ask any of the Government or Opposition Members to call into Roscommon County Hospital to check the position for themselves because it is busier now than it was two years ago and patient safety is much better.

Deputy 'Ming' Flanagan was not around Roscommon County Hospital last Wednesday when I sat with the design team for the new €3 million endoscopy unit. He was not there last Thursday when the €4 million palliative care unit at the back of the hospital was going to be announced, or on Thursday evening when we opened a primary care centre in his own town of Castlerea, or on Friday when we outlined what exactly is happening in Roscommon County Hospital. I ask those opposite to call into the hospital, have a look to see what is happening and get off their high horse because each and every one of them have shouted for a year and half but I and this Government have delivered.

I want to say one thing. I have the fullest of confidence in the Minister, Deputy Reilly, in the excellent job he is doing, the fullest of confidence in the Minister of State, Deputy Shortall, and in the Minister of State, Deputy Kathleen Lynch, and I believe that time will prove us right.

Deputies

Hear, hear.

I welcome the opportunity to contribute to the debate on the motion. When the country is facing one of the toughest budgets we have ever had to face, I am disappointed Fianna Fáil has tabled a politically opportunistic motion.

I wonder what has happened to its leader's call for a constructive Opposition that would not look for political gain from tough Government decisions. He seems to have forgotten about that in the same way, perhaps, as he has forgotten about his tenure at the Department. Let us consider the facts about his time in the Department. While Deputy Martin was Minister, there was a €600 million overspend and it had to be made up by additional budgets signed off by the Cabinet. That is not a luxury we have anymore. He spent €14 million on 50 consultant reports. We all know what happened and how many of the recommendations were implemented.
Under the Minister for Health, Deputy Reilly, we have seen a 20% cut in the number of people waiting on trolleys. There has also been a reduction of 85% in those waiting 12 months or more for surgery. Also, local improvements have been made, including a new primary care centre opening in Ashbourne, County Meath, and we believe there is one on the way for Kells. Some things are improving, although not as fast as we would like. It will take time to fix the mess left over from Fianna Fáil but we are the people to fix the mess.

This Government was elected 18 months ago on a mandate from the people for reform, including reform of our health system, which was left on life support by the previous Government. Before the election Deputy James Reilly said: "I know there will be blood on the floor and I know some of it will be mine, but I relish the prospect of being health Minister." Nobody can claim he was complacent coming into office. He knew it was going to be tough, and it is tough but so is he.

Let us look at what has happened in the past year. The Minister is overseeing radical changes to replace the dysfunctional aspect of the HSE, initiating its replacement by a seven-person directorate overseeing hospital care, primary care, mental health, children and family services, social care, public health and corporate services. One of the biggest projects initiated was the immensely successful setting up of the special delivery unit in the Department of Health. The figures speak for themselves. The initiative has already brought about a 20% year-on-year reduction in the number of patients waiting on trolleys; a reduction from an all-time high of 569 patients on trolleys on 5 January 2011 under the Fianna Fáil Government, to 139 on 7 September 2012, a 75% reduction. Overall, surgical waiting list numbers have decreased by 7%, while those waiting over 12 months have decreased by 85%, and those waiting over nine months by 63%. A national carers strategy was published over the summer. New legislation that grants every qualified GP the automatic right to treat medical card patients, represents a watershed moment in the history of Irish medicine. We saw the introduction of a cervical cancer vaccination catch-up programme for all girls in secondary schools.

In May of this year the campaign group Mental Health Reform welcomed the Minister's decision to proceed with establishing a new structure for the HSE. It will include a new directorate of mental health. This week, an agreement was reached with hospital consultants and health service management that will generate savings up to €200 million through new rosters, saving 70,000 bed days. Large capital projects take time to deliver, and this Minister will deliver. I have every confidence in him.

After 18 months of this Government, Fianna Fáil has tabled a motion of no confidence in the Minister for Health. Its Members have some neck. Let us consider the record of Fianna Fáil in government, such as Charles J. Haughey, a man who single-handedly brought disgrace to the office of Taoiseach; Michael Woods, who negotiated with religious orders as Minister for Health during the course of child sexual abuse, and Brian Cowen, who referred to the Department as Angola and single-handedly brought the nurses of this country onto the streets.

Can Deputy Keating remember what party he was in? What party will he be in next week?

Deputy Martin is absent again. We must consider his record of attendance, when the Taoiseach, the Tánaiste and the Minister for Health are speaking on an important matter. He spent millions of euro of taxpayers' money on reports and never implemented one of them. He was responsible for running over budget every year while he was Minister with responsibility for health.

Fianna Fáil Members should be ashamed of themselves. This is not about the Minister for Health, Deputy Reilly, but about the competitive edge between those on my left on the Opposition benches and those on my right. We saw it on television last night, in recent opinion polls and in the last election.

Deputy Keating should look at those polls again.

As spokesperson for health, the Deputy is driving himself into another cul-de-sac.

It will be tight in Deputy Derek Keating's constituency.

If the Fianna Fáil Members had any decency, they would withdraw the motion before 9 p.m.

The Labour Party Members cannot wait to vote for the Minister for Health. They can register their votes as they leave the Chamber. It is important to realise why the motion was tabled by our party. I assure the Ministers, Deputies Reilly and Rabbitte, that it was not for political opportunism, far from it. Whether Government Deputies accept it or not, confidence in the ability of the Minister to manage the health service has been lost. Despite using the comparison with Bill Clinton last night, it would be more in his line for the Minister to look at the facts, which speak for themselves. The Minister is no Bill Clinton.

He is more like John Wayne.

The Labour Party Ministers of State in his Department and in the Government were not informed about more recent announcements on further cutbacks because of his inability to deliver the budget he had promised. When he comes under pressure, he hits out at the Croke Park agreement and sick pay. In his speech last night, he said it was ironic that Fianna Fáil was tabling the motion. He ignored any accountability at his Department. The Minister denied that he cleared the cuts or that he hid behind the HSE and allowed it to make the announcement.

I never denied anything, unlike Deputy Barry Cowen.

He refused media interviews, despite the fact that he was asked by numerous outlets on numerous occasions. He had the audacity to blame the Opposition for the fact that disabled people were protesting overnight three weeks ago. He said that his message was lost and that he found it impossible to communicate clearly that they would not lose the service because of the fog created. How could he do so because he only had one interview? In that, he decided to throw in the Croke Park agreement. After the week of negative publicity and more chaos, particularly from the Labour Party Chairman and others, the Minister met his Cabinet colleagues and was told to sort out the mess he had created. He then announced a U-turn and the Taoiseach congratulated him on his bravery. Then, the Minister did a "Prime Time" interview and denied that he had done a U-turn.

That weekend, one could not get onto local radio stations throughout the country because the Labour Party Members were queueing up to tell everyone what they would say to the Minister and how the cuts would be reversed. The same Labour Party Members will be tripping over themselves to vote for the Minister. There is a pattern of the Minister blaming everyone but himself. He has been in office for the past 18 months and has been very busy relabelling and announcing initiatives started by the previous Government. Last night, he spoke about irony but he had no scruples in blaming Deputy Micheál Martin, who left the Department eight years ago in 2004. I will say a little about the list of previous Ministers provided by the Minister for Finance, Deputy Noonan. He failed to mention his tenure when he set up tent in it and had to get out of it pretty quickly.

The Minister for Health also referred to being a GP and how he came to politics late. He did not elaborate on how steeped he was in medical politics in the IMO. There is nothing wrong with that but there is an irony in it when he speaks about delays in negotiations with the IPHA on drug costs and the consultants on the reimplementation of the 2008 contract, given that he presided over the most lucrative deal ever for GPs during his presidency of the IMO.

This ties in with his rallies around the country before the last election. Promises on Monaghan hospital were made by the Minister for nothing but blatant political gain. He knew full well that the promises could not be implemented. In addition to those broken promises, the Taoiseach made a promise on Roscommon hospital. He denied it until the tape was produced and he had to retract.

Last night, the Minister for Communications, Energy and Natural Resources, Deputy Rabbitte, said Deputy Martin should crawl under a stone in the Burren because of what he had done to the country - another typical headline-grabbing superficial account of a global and European economic crisis. He rarely speaks now of his past, be it in the Democratic Left or the Workers Party. We will not have any retrospective comments on that, of course.

The Minister for Health commented last night on how patients are always at the centre of the decisions he makes. Why then did he cut thousands of hours of home help, and why is his inaction on the budget to result in ward closures all over the country? These are facts that he will not be able to contradict or twist to his own advantage.

The Euro Health Consumer Index, EHCI, regularly assesses patient services across the Union. In 2005, it ranked Ireland, in terms of the quality of its health service, as 25th out of 26 European countries. However, four years later and following the introduction of the HSE, which was in 2005, Ireland was ranked 13th out of 33 countries. The body stated the creation of the Health Service Executive was obviously a much-needed reform.

It is ironic that, before the Minister’s time in this House or Fine Gael, his party supported the formation of the HSE. Deputy Olivia Mitchell said, "I welcome the reforms, as does Fine Gael, and we accept the need for a more centralised administration and for a clear chain of command through the health service, which was lacking."

It is still lacking.

The Minister said last night that he did not get rid of the HSE, yet, with great fanfare, he announced the abolition of its board as he wanted to be in charge. He replaced the board with officials so we had the farce of the CEO on the board writing to Department officials about budget concerns, with no one actually accountable. This was the Minister's decision and no one else's.

We are far more accountable than Fianna Fáil ever was.

There is no doubt that the HSE structure was not perfect but patient outcomes have improved under its direction. Developing a modern integrated health service is a difficult journey but at least the last Government bedded down the right policy of putting patient outcomes at the centre of its health policy, irrespective of whether this is accepted by the Deputies opposite.

The Minister is talking about reform for reform's sake and political gain while chaos continues to reign across the health service. Dismissing the HSE board on his appointment was obviously his choice but his biggest failing was not putting a governance structure in its place. A massive drift was allowed to develop not only with budget deficits, but also regarding reforms that the Government promised before and after the election. One of these commitments is the introduction of free GP care for patients with long-term illness, yet we were told by the media a few days ago that there are legal issues as long-term illness is hard to define on an income basis. Why, then, was this initiative announced numerous times before the legal issues were checked? Is this a smoke screen?

It is worth noting for the record that the IMO has yet to be consulted in regard to this initiative. This flip-flopping is causing confusion among those with long-term illnesses. It is making them lose confidence and become very cynical about political promises such as those the Minister has given. Staff in the health service face challenges every day. They are seriously concerned about how directionless the health service has become. As early as last April, the all-party Oireachtas Committee on Health and Children was informed that budgets were overrun, in some cases in the order of up to €10 million. The regional hospital in Limerick had an overrun of €9 million and the hospital in Cork had an overrun of €5 million. The hospital in Galway had an overrun of €7 million and Dublin hospitals had overruns of up to €9 million, yet there were no actions to correct the deficits, even at the time in question. These overruns added to the inability to make the savings promised in last year's budget. Owing to the necessary legislation not having been produced on time and the negotiations on drug costs not having been finalised, there will be cuts to stretched services.

Issues pertaining to the health service should be debated openly in this House. There is no point in having a budget based on false expectations. This only adds to the pressure that the service is under. This House should support our motion.

I wish to share my time with a number of colleagues.

Some weeks ago, HSE officials at senior level, but not including the recently appointed CEO designate, announced on behalf of the Minister a reduction of €130 million in his Department's programme of expenditure for 2012. The reductions affecting so many critical services stemmed directly from the absolute mishandling and presentation of the Minister for Health's Estimate for this year. We all realise the challenges that arise in funding the health service but, regardless of these challenges, the Estimate must be managed properly right from the start of the year.

It was pointed out repeatedly from early on in this year that the Estimate did not stack up. In the immediate aftermath of the announcement, Members on the Government side distanced themselves as much as possible from the Minister, Deputy Reilly. Strikingly, even the Minister for Social Protection, Deputy Burton, refused on more than one occasion to express confidence in the Minister for Health. The non-working relationship between Ministers in the Department of Health has been well-documented. Such non-working relationships are damaging the implementation of departmental plans and governance. What leadership is that?

Ministerial colleagues were not informed by the Minister for Health of the cutbacks or the resignation of the former CEO of the HSE, Mr. Magee. Those strained relationships must be to the detriment of providing services in what are challenging times. The Minister of State, Deputy Shortall, learned through media reports of the departure of the CEO of the agency charged with the delivery of health services. This clearly demonstrates the breakdown of a proper working relationship within the Department, never mind within the Government.

We all understood that the Minister of State, Deputy Shortall, had been delegated responsibility for the primary health sector, but we learnt through the extraordinary correspondence between the Minister and the Minister of State that no such delegation of powers had been effected 18 months after the ministerial appointments. That correspondence dealt with the blame game over budgetary overruns in primary care. The Minister of State, Deputy Shortall, clearly identified overrun problems emanating directly from the Minister's failure to generate savings on the drugs bill or through recoupment from the insurance companies. Clear commitments had been given at budget time by the Minister to effect such savings and the failure to do so has now had an impact on people with disabilities and the elderly. Where is the accountability when a Minister fails to bring through Government the delegation of powers to a Minister of State in such a critical area of administration?

Some six months ago, the then HSE CEO warned of the impending difficulties with the health Estimate, and that was brought to the attention of the Department of Public Expenditure and Reform. Over the years, there have been particular difficulties in the north east with the reconfiguration of services. A number of hospitals in Louth, including Dundalk, and Navan, Monaghan and Cavan come to mind. Over the years there has been a reconfiguration of services but it has not been completed. However, the reconfiguration that has taken place has brought about improved services in many areas. Those of us in public life have had to deal with particular difficulties in this regard. Current Ministers, including Deputies Noonan and Howlin, and former Taoiseach Brian Cowen and Deputy Martin all dealt with these issues. We faced up to them by prioritising the need to put the patient and safety first. This was not always the case in that members of the Fine Gael Party and the Labour Party, when in opposition, criticised the reconfiguration that was necessary and which has brought about improved services.

When the current Minister for Health was the Opposition spokesperson, he gave clear commitments in County Monaghan from the back of a lorry that the people of Monaghan would have to access fewer health services in Cavan and that they would be able to access more in Monaghan General Hospital. He stated at the time that fewer patients from Monaghan would travel the Cavan road to gain access to health services. In this regard, we should note what has happened in the past 18 months. The minor injury unit at Monaghan General Hospital has had its opening hours and services reduced. A proposal to provide a medical assessment unit at that hospital has been reviewed time and again. Some years ago, a very successful medical assessment unit was developed at Cavan General Hospital.

That unit allowed other specialist services to be brought to Cavan General Hospital for the region. Previously, those services could only be accessed at one of the Dublin teaching hospitals.

As the Minister knows, the development of a service does not necessarily entail additional expenditure in the health budget. I implore him to act on the promises he gave to the people of Monaghan to the effect that additional services would be provided at Monaghan General Hospital. The proposals before his Department are sensible and practical and would not incur additional expenditure.

The background to this motion is the chaos obtaining in the health service. Planning certainty is essential if we are to have a dependable health service. Decisions to slash spending two thirds of the way through the year is a recipe for disaster. Cutting overtime and agency staffing in Our Lady of Lourdes Hospital, Drogheda, and Louth County Hospital without having a proper alternative plan in place will put patient safety at risk at both sites. I was accused of scaremongering by some Government backbenchers when I raised this matter recently.

The disability sector did not escape the axe. There was a U-turn and the mental health budget was raided to plug the budget gap. The health budget was framed on the basis of a saving of €124 million in drugs payments. An additional €140 million was to come from increased private income, but the facilitating legislation is yet to be published. Signing off on a budget with this level of uncertainty is irresponsible.

In the budget, €35 million was earmarked for mental health services. On 6 September, funds were diverted to deal with the health service deficit elsewhere. Of the €70 million set aside for primary care, mental health services and the extension of the free general practitioner, GP, scheme, €53 million will be cut.

Fianna Fáil believes that savings can be made in a number of areas. For example, high agency costs arise due to absenteeism, which amounted to 5% in the first quarter of 2012 compared with a level of 2.5% in the private sector. The cost of taxis increased by almost 10% last year, up from €26 million to €28 million. Overtime amounted to €170 million last year and €69 million in the first five months of this year. Agency staff costs will exceed €200 million this year. Medical legal payments have increased from €39 million in 2008 to a projected €127 million in 2012.

An important Department needs proper, systematic planning. Cutting services two thirds of the way through the year is a recipe for disaster. The Minister would be the first to recognise the range of areas that will be affected by these cuts. Had we proper planning, February or March would have been the time to make adjustments to the budgetary position on a scale that would have had less of a detrimental impact on the range of services being provided to people in urgent need. Lessons must be learned from this year's budgetary chaos if we are to ensure the situation is not replicated next year or the year after.

I do not intend to personalise this debate as others on both sides of the House have done. The issue of health care is too important. It affects families and individuals throughout the country. I have always found the Minister, Deputy Reilly, to be personable.

I do not doubt that the Minister will easily survive the confidence motion despite the serious misgivings of numerous Government backbenchers in recent weeks. It is clear that the Minister gave a rousing speech at the Fine Gael think-in, given the fact that the party's benches are now full in a show of support. After winning the motion, I would urge the Minister to listen to me and to change tack.

I acknowledge the strong mandate that the Government parties received to govern 18 months ago. As the main Opposition party, we similarly received a mandate to hold them to account. The Government's mandate was based on election commitments and promises. As a Fine Gael spokesman on health, the Minister made multiple pledges around the country. Various Deputies spoke of commitments regarding their respective constituencies.

I will focus on two overriding commitments made by the Minister, namely, the money would follow the patient and the HSE would rightly be held accountable to the Minister of the day. One of the Minister's first actions in office was to disband the board of the HSE and appoint officials from his Department. It is funny that the Minister for Children and Youth Affairs, Deputy Fitzgerald, is proposing a similar structure to the HSE's for the new child and family services agency when the Minister for Health is dismantling the HSE.

The Minister, Deputy Reilly, was going to take control. The public had high hopes. He had considerable experience in the health profession and superb negotiating skills. During his time at the helm of the Irish Medical Organisation he negotiated the most lucrative contract in the history of the State for GPs. We are still paying dearly for that today.

That is where the high hopes ended. Last night, the Minister mentioned reductions in time spent on waiting lists. This might be easy to achieve, given the extension of the time parameters. While it might be good politics, it is not good for end users. Day in, day out, people attend Deputies' clinics explaining the long delays they have experienced when seeking necessary treatment.

We will discuss the Minister's budget primarily and the deficit of €259 million in the HSE's Estimate. He tries to blame the staff and the Croke Park agreement, but I will quote the Minister for Public Expenditure and Reform, Deputy Howlin, who stated, "There are some, and I've heard it in recent days, who almost use Croke Park as a shield for their own inactivity".

(Interruptions).

This is a very serious issue. Perhaps the Ministers could listen or leave the Chamber if they find it so funny. The state of the health services is not funny. The Minister has failed to realise savings of €124 million in respect of drugs and savings of €140 million from changes to bed designations, a matter on which legislation has not been tabled. When the proverbial was going to hit the fan, he punched and pounded on society's weakest and most vulnerable-----

-----to reach the targets set out in a budget that was his and no one else's. Society's weakest and most vulnerable camped outside Government Buildings overnight because of decisions he made or proposed to make. They depend on personal needs assistants. The airwaves were full of Government backbenchers who were rightly disgruntled and annoyed by the way the matter was handled.

The Minister mentioned cutting home help hours. Home help is keeping many people out of residential care and saving the State tens of millions of euro annually. Then he set a deadline for negotiations with consultants. Where exactly will the €200 million in savings be made, given that only the pay of new consultants will be reduced?

Once again, it is an easy target and sitting duck for the Government; it will attack new entrants and create a great disparity between them and existing staff.

God help them they will only have €120,000 per year.

The €3.5 million man.

This morning, during Leaders' Questions, we heard the Taoiseach telling us how he requested his Ministers last week to explore how best to squeeze the maximum savings from the Croke Park deal. I would have thought it more appropriate to ask the Ministers to consider that issue on the first week of the Government's term in office rather than 18 months later.

I will deal with the issue of money following the patient. I have used the example of Mullingar Regional Hospital time and again and I will provide more recent figures tonight.

I would welcome it.

At the end of August 2012, the hospital had 13,593 inpatient charges, with an average length of stay of 3.39 days. It dealt with 4,748 day case procedures. Overall activity in the hospital is 2.5% ahead of activity for the same time last year while the hospital expenditure runs at €1.09 million less than last year.

The figures last year were better than the year before as well. What is the Deputy's point?

The hospital has reduced the number of staff working-----

The Deputy is guessing.

-----from 751 to 732, with the absenteeism rate falling from 7.96% to 5.45%.

Fianna Fáil said it could never be done.

He sounds like a great Minister.

It was not the Minister, Deputy Reilly, or with due respect, the Minister of State, Deputy Lynch, who achieved this. The staff of the regional hospital in Mullingar achieved this.

The management of the hospital achieved it.

Deputies

Hear, hear.

I ask the Minister, as I have done time and again-----

What were they doing when Fianna Fáil was in office?

They have been doing it repeatedly over the years. For the past five years it has been one of the most efficient hospitals in the country. I have asked the Minister to visit the hospital and I do so again. He was in Westmeath a number of months ago to open a new long-term residential care facility.

The Deputies want to throw him out.

We will have to wait until after the vote.

He did not look at the hospital.

Is the Deputy looking to sack him or extend an invite?

The Minister thought he was Santa Claus.

There is a time limit on this debate. The Deputy's time is up.

To conclude, as Opposition health spokesperson, the Minister indicated he would walk-----

-----if he had to cut or otherwise affect front line services. I know the Minister will not walk tonight but he should change tack in order to get support from all Members of this House.

To follow Deputy Troy's comments, it seems he is extending a very warm invitation. He must not have much confidence in winning the vote tonight if he is inviting the Minister to Mullingar.

I acknowledged that in my opening comments.

The Deputies were too busy cracking jokes.

Deputy Troy's other compliment to the Minister related to when he was in charge of negotiations for the Irish Medical Organisation, IMO. The Deputy did not mention the other person who got the very bad deal at the other end, the current Fianna Fáil Party leader, who was the Minister responsible for health at the time.

I presume the Minister gave the Minister of State that line.

That should have been mentioned.

Will we have a proxy statement?

It is correct that it was a very one-sided deal.

There is a man there now who can rescind it if it is that bad.

Unfortunately, the people representing the Government on that day did not do a very good job. The Deputies should keep that in mind.

The Government can change it so.

When the Government came into office 18 months ago there was a deficit of €20 billion. There are many health issues this Government would like to tackle, and nobody is denying people are suffering because of mortgage debt, unemployment etc. If we had the type of resources that Fianna Fáil had when it was in government over the past 18 years, we would now have an entirely different country.

We now have to go about reducing the amount of money we can spend, as we are not in control of our finances, and that is down to Fianna Fáil. If we had its resources, we would have a health system in the top three.

The Government said it would do that anyway.

The Government will not be long in bringing it down.

We must now set about not just reducing our budget but reforming an entire system. Despite our reduced budget, those reforms are taking place. I am responsible for the mental health area, and for the first time ever we are seeing progress.

A Vision for Change was published in 2006, which was in the middle of the economic boom.

The Minister of State's party was looking for us to spend.

Nothing happened.

That is not what the Minister of State said about Inclusion Ireland.

What about the €35 million?

The amount of progress made was minuscule.

Opposition Deputies will have 15 minutes to respond.

We are at last beginning to see improvement on mental health issues.

There is no money.

Allow the speaker to continue. Deputies will have 15 minutes to respond.

Other Deputies have pointed out the advances made in general hospital practice and paediatrics. We are about to build the national children's hospital.

The Government is always "about to".

Deputy Burton is smiling.

We are going to replace the Central Mental Hospital.

She will write another letter.

This is in the middle of the worst crisis that this country has ever seen.

The danger will have to be cleared in the Department of Health.

It is all the fault of Fianna Fáil. We are about to do the type of infrastructural work that it should have done over the past 20 years.

A detailed analysis.

It could not do so because as Deputy Troy has said, there was no planning or vision. At least we have a vision-----

The Department has vision with no sound.

We have a plan and we are committing to it.

The Government will never do it.

The plan will be carried to the end.

Does the Minister of State have confidence in her Minister?

It will happen despite the state in which Fianna Fáil left this country.

The Government promised the sun, moon and stars before the last election. It has done nothing.

Does she have confidence in the Minister?

It will happen despite the state in which Deputy O'Dea's party left this country. When the 19 Members in Fianna Fáil - all men, I notice - were elected, they decided it was time for contrition. They were going to Purgatory but they do not do that for long. They have decided they must be forgiven and they are already back out there.

We never did it. The Minister of State would not know what Purgatory was.

The term "brass neck" would not describe this motion.

The Minister of State should tell us about how she has confidence in the Minister, Deputy Reilly.

Does she have confidence in the Minister?

Fianna Fáil have some cheek.

Will the Minister of State write another letter?

The Minister, Deputy Rabbitte, did not say last night that he asked Deputy Martin to crawl under a rock in the Burren and commune with nature but rather that if he were Deputy Martin, he would crawl under a rock and commune with nature. There is a subtle difference. Fianna Fáil is a disgrace.

The Minister of State is avoiding the issue.

Before I finish-----

I am sorry but the Minister of State is over time.

Does she have confidence in the Minister?

This is the second time-----

A Labour Party Minister has not indicated confidence in the Minister, Deputy Reilly.

-----this coalition of Fine Gael and Labour have had to clean up Fianna Fáil's mess.

Deputies

Hear, hear.

Does she have confidence in the Minister?

I have every confidence in the Minister for Health, and he is doing a tremendous job in appalling circumstances.

Send him a letter.

Last year, we had to take €500 million from the health budget.

The Minister of State is way over her time. She should resume her seat.

This year we will have to take €500 million from the health budget again. When the Members opposite knock on people's doors, they will have to tell people why we had to do that.

The Minister of State should resume her seat. I call Deputy Calleary. This is a restricted debate with a time limit. I have a duty to call a vote after 90 minutes tonight. I ask people to behave responsibly. It is all right to have a bit of banter but speakers should not be shouted down.

That applies on both sides.

How much time remains in the slot?

There is now officially ten minutes.

Deputy Kelleher and I are sharing the slot.

I thank Deputy Kelleher for giving the House a chance over the past two evenings to discuss the current state of our health service. It is in the state it is primarily because of the very flawed budget presented to the Dáil last December, the flaws of which Deputy Kelleher has highlighted on numerous occasions in the Chamber and at meetings of the Oireachtas Joint Committee on Health and Children. The flaws were also highlighted last June by the then CEO of the HSE, Cathal Magee, without any action being taken by the Minister, Deputy Reilly.

Flaws were also highlighted by the Minister of State, Deputy Róisín Shortall, who in her speech this evening never mentioned the Minister. She never once referred to the Minister by name. She wrote to the Minister and identified €124 million worth of savings in the Department that were, to use her phrase, within the purview of the Minister which had not been identified and made. As a result, three weeks ago tomorrow the Minister announced €135 million worth of reductions. However, tonight the Government amendment to the motion praises the Minister for the effective manner in which he manages the resources, despite the fact he will make reductions of €135 million.

This reduction was announced three weeks ago but we still do not have specific details on how it will impact on the ground in each region. On two occasions HSE meetings were cancelled or postponed because the script from the Department of Health kept changing with regard to the cuts. We must deliver €135 million in cuts within three months. This is €45 million a month because of a flawed budget which could have been corrected in February when Deputy Kelleher first identified the issue.

There will be a significant vote of confidence in the Minister this evening because of this effective handling of the Department. However, all of the Deputies who will vote confidence in him when the detail arrives on their desks in the coming weeks of cuts to home help services, to hospitals, to community services-----

We will know who to blame.

I will give the example of a group which organised awareness training on suicide for volunteers in youth organisations. They had to cancel a course for 30 people at the weekend in Westport because the HSE people were not allowed to travel. Even though the group was willing to pay their travel expenses they could not proceed. This is what will happen. Tonight Deputies will vote away their credibility to go on local radio stations and threaten early elections because they will vote confidence in the effective way in which the Department of Health budget has been handled.

Yesterday evening, the Minister outlined a large number of achievements in the Department and some of them are really good. Something to which he did not pay much attention is the opening of the GMS scheme so every doctor can have a role in it. This is very important and the old James Reilly would never have done it. It is a good achievement. However, the Minister did not look at the fact that many of the achievements he outlined are being undermined on a daily basis. Where will the waiting lists, which have been trumpeted this evening, be in December? The point Deputy Troy was trying to make was despite the fact that hospitals have made huge efforts, those which were successful, and I include Mayo General Hospital, had their budgets cut even further and they do not receive any credit for the fact they took locally-based decisions. As a result, they are cancelling elective surgery as we speak. People cannot get an appointment to see a consultant to get on a waiting list. If people cannot get on a waiting list it is no wonder the waiting lists are being reduced. I look forward to the Minister coming back in December and giving us an idea of the waiting lists then.

It was worse during the Fianna Fáil years.

Deputy Calleary has a very selective memory.

This evening the Tánaiste spoke in defence of the Minister for Health and I congratulate the Government Chief Whip on the manner in which he has all the boys and girls in the choir behind the Minister this evening. Fair dues to him, the Minister owes him a drink.

Deputy Calleary sang himself when the IMF came to town.

The Tánaiste spoke of his confidence in the Minister but he never spoke about his party chairman's lack of confidence in him and the comments he made about him not only on local radio, but on national radio. He did not refer to the fact that the Minister, Deputy Burton, and the Minister of State, Deputy O'Sullivan, who are here this evening performed Olympian gymnast standard efforts to avoid stating on air they had confidence in the Minister. It is a shame they were not in London because we would have two more gold medals to celebrate this evening. The Minister of State, Deputy Lynch, just about mentioned the Minister by name at the end of her speech. She pointed out all of the achievements in mental health but they are because of her. She previously referred in very good terms to her predecessor, John Moloney, and the manner in which she reverted to the tribe this evening was not fair to him because he implemented a large amount also. The achievements in the area of mental health have nothing to do with the Minister, Deputy Reilly.

The key problem for the Minister is that before the election, when he was Deputy James Reilly, the deputy leader of his party and spokesperson on health, he travelled the country and, unlike what the Taoiseach stated this evening, he engaged in a cynical campaign. He made promises in Sligo, Roscommon, Navan, Monaghan and Ennis and to thalidomide and symphysiotomy groups. He opposed the implementation of the transformation of the cancer control programme. Usain Bolt would not have kept up with the Minister in his rush to jump on trucks around the country to tell every community group he would look after it.

Did the Deputy ever see me on the back of a truck?

As soon as the Minister got here he turned his back on them. He turned his back on Roscommon, Navan, Sligo and all of the groups he could not talk to, hug and love enough before he came to office.

And the Deputy turned his back on the country along with his party.

This is the damage and why it is so difficult for the Minister to stand up and have credibility.

I know the Minister has had a rough few nights and the Minister, Deputy Noonan, wanted us to apologise for roughing him up and highlighting this issue. The Chief Whip has ensured a group hug for the Minister this evening.

Do I look roughed up to the Deputy?

Many people will vote confidence in the Minister this evening. All of the Government backbenchers are arriving in to vote confidence in him. However, there is a difference between voting confidence and having confidence. All of the off the record briefings in the Knockranny House Hotel and Carton House are what count and reflect the Deputies' real opinion of the Minister.

Yesterday evening, the Minister quoted Bill Clinton in his defence. I will quote him back. He once stated it is just one small step from legacy to lame duck. The Minister's foot is on that step.

I welcome all the contributions made on the motion of no confidence in the Minister, Deputy James Reilly. Tabling this motion was not a cynical exercise. It gave us an opportunity to highlight the inadequacies and failings of the Minister in managing a budget. This is why Martin Naughton was protesting outside the gate two weeks ago. The words the Taoiseach stated were inspirational, but the reason he was out there was because the Minister, Deputy Reilly, is incapable of managing a budget.

The contribution made this evening by the Minister, Deputy Noonan, may have been a bit glib and sarcastic but perhaps he would do us a favour and give the Minister, Deputy Reilly, a basic lesson in sums because he included in the budget programmes that were not sustainable or achievable. All he was short of was writing in that we will find a crock of gold somewhere to keep the budget going for as long as we can.

The most interesting contribution made over the past two evenings-----

It was not from your leader anyway. It was not Deputy Micheál Martin.

It was not from you either.

-----by any Member of the House was that made by the Minister of State, Deputy Róisín Shortall. She spoke for four minutes and it was not a statement but an open letter to the Minister. She was putting him on notice. She did not refer to him once but she highlighted his failings and those of the Department and the HSE in dealing with the budget overrun. She stated quite clearly in her statement that the priorities outlined in the programme for Government must be brought back into being. These include primary care. Great promises were made but we are now told there are constitutional and legal problems with the legislation and €15 million has been pocketed to fill the gap in the budget deficit caused by the shortcomings of the Minister, Deputy Reilly.

This is not about political opportunism. It is about whether the Minister, Deputy Reilly, is capable of delivering not only on the commitments, but in ensuring the most vulnerable are protected. Quite clearly when the axe did fall it was on the most vulnerable and there is no point in anybody else coming to the House trying to convince otherwise those who were outside Government Buildings two weeks ago and those from whom home help and home care packages were withdrawn and whose packages were threatened to be withdrawn. This is the simple fact. Many Deputies stated this publicly on the airwaves but this evening they will vote confidence in the Minister. They will do so with a very heavy heart but tomorrow they will still be stating they do not have confidence in him. When the Minister of State, Deputy Shortall, could not come here this evening and stand up and state she had confidence in the Minister then we have a major dysfunctional problem in the Department of Health and it says much about the Minister.

I did not make any personal insults; I want to keep it on the issue of policy. However, the Minister has failed fundamentally. He came into office as the great white hope with promises and commitments to transform the health service. Every one of his commitments is being continually delayed.

Absolutely not.

The Taoiseach had the brass neck to come into the House and say his mandate was not that of solving promises. He cannot even go to Roscommon because of the commitments and promises he made to the people there which he denied he ever made. Let us be clear. Lots of promises were made but they have not been kept.

The Deputy's party leader is so committed, he did not contribute to the debate because he is embarrassed by his own record.

If you are not, you ought to be.

Through the Chair, please.

Does the Minister really want to get into it?

The Minister promised fundamental change but he has failed. However, the Taoiseach came into the House this evening and said one of his greatest achievements was the renegotiation of the consultants' contract. The Minister can take credit for lots of things but he certainly cannot take credit for something which happened in 2008 and was referred to the Labour Relations Commission for adjudication only two weeks ago. For people to come into the House and take credit for something in which they did not have hand, act or part is brass neck of the highest order.

The Deputy has a brass neck. His party caused the problem.

(Interruptions).

Before Deputies vote confidence in the Minister, they should remember what they said on local radio stations and at Carton House and what they say daily to their constituents, because each of them is voting very hypocritically.

The Deputy has a brass neck.

(Interruptions).

I look forward to reading the open letter from Minister of State, Deputy Shortall, to the Minister, putting him on notice for his failings so far.

Amendment put:
The Dáil divided: Tá, 99; Níl, 49.

  • Bannon, James.
  • Barry, Tom.
  • Breen, Pat.
  • Bruton, Richard.
  • Burton, Joan.
  • Buttimer, Jerry.
  • Byrne, Catherine.
  • Byrne, Eric.
  • Carey, Joe.
  • Coffey, Paudie.
  • Collins, Áine.
  • Conaghan, Michael.
  • Conlan, Seán.
  • Connaughton, Paul J.
  • Conway, Ciara.
  • Coonan, Noel.
  • Costello, Joe.
  • Coveney, Simon.
  • Creed, Michael.
  • Daly, Jim.
  • Deasy, John.
  • Deenihan, Jimmy.
  • Deering, Pat.
  • Doherty, Regina.
  • Donohoe, Paschal.
  • Dowds, Robert.
  • Doyle, Andrew.
  • Durkan, Bernard J.
  • English, Damien.
  • Farrell, Alan.
  • Feighan, Frank.
  • Ferris, Anne.
  • Fitzgerald, Frances.
  • Fitzpatrick, Peter.
  • Flanagan, Charles.
  • Flanagan, Terence.
  • Gilmore, Eamon.
  • Griffin, Brendan.
  • Hannigan, Dominic.
  • Harrington, Noel.
  • Harris, Simon.
  • Hayes, Tom.
  • Heydon, Martin.
  • Hogan, Phil.
  • Howlin, Brendan.
  • Humphreys, Heather.
  • Humphreys, Kevin.
  • Keating, Derek.
  • Keaveney, Colm.
  • Kehoe, Paul.
  • Kelly, Alan.
  • Kenny, Enda.
  • Kenny, Seán.
  • Kyne, Seán.
  • Lawlor, Anthony.
  • Lynch, Ciarán.
  • Lynch, Kathleen.
  • Lyons, John.
  • McCarthy, Michael.
  • McEntee, Shane.
  • McFadden, Nicky.
  • McGinley, Dinny.
  • McHugh, Joe.
  • McLoughlin, Tony.
  • McNamara, Michael.
  • Maloney, Eamonn.
  • Mathews, Peter.
  • Mitchell, Olivia.
  • Mitchell O'Connor, Mary.
  • Murphy, Dara.
  • Murphy, Eoghan.
  • Nash, Gerald.
  • Neville, Dan.
  • Nolan, Derek.
  • Noonan, Michael.
  • Ó Ríordáin, Aodhán.
  • O'Donnell, Kieran.
  • O'Donovan, Patrick.
  • O'Dowd, Fergus.
  • O'Mahony, John.
  • O'Reilly, Joe.
  • O'Sullivan, Jan.
  • Phelan, Ann.
  • Phelan, John Paul.
  • Quinn, Ruairí.
  • Reilly, James.
  • Ring, Michael.
  • Ryan, Brendan.
  • Sherlock, Sean.
  • Shortall, Róisín.
  • Spring, Arthur.
  • Stagg, Emmet.
  • Stanton, David.
  • Timmins, Billy.
  • Tuffy, Joanna.
  • Twomey, Liam.
  • Wall, Jack.
  • Walsh, Brian.
  • White, Alex.

Níl

  • Adams, Gerry.
  • Boyd Barrett, Richard.
  • Broughan, Thomas P.
  • Browne, John.
  • Calleary, Dara.
  • Collins, Joan.
  • Collins, Niall.
  • Colreavy, Michael.
  • Cowen, Barry.
  • Crowe, Seán.
  • Daly, Clare.
  • Doherty, Pearse.
  • Ellis, Dessie.
  • Ferris, Martin.
  • Flanagan, Luke 'Ming'.
  • Fleming, Sean.
  • Fleming, Tom.
  • Halligan, John.
  • Healy, Seamus.
  • Healy-Rae, Michael.
  • Higgins, Joe.
  • Kelleher, Billy.
  • Kirk, Seamus.
  • Lowry, Michael.
  • Mac Lochlainn, Pádraig.
  • McConalogue, Charlie.
  • McDonald, Mary Lou.
  • McGrath, Finian.
  • McGrath, Mattie.
  • McGrath, Michael.
  • McGuinness, John.
  • McLellan, Sandra.
  • Martin, Micheál.
  • Moynihan, Michael.
  • Murphy, Catherine.
  • Naughten, Denis.
  • Nulty, Patrick.
  • Ó Caoláin, Caoimhghín.
  • Ó Fearghaíl, Seán.
  • Ó Snodaigh, Aengus.
  • O'Brien, Jonathan.
  • O'Dea, Willie.
  • Pringle, Thomas.
  • Ross, Shane.
  • Smith, Brendan.
  • Stanley, Brian.
  • Tóibín, Peadar.
  • Troy, Robert.
  • Wallace, Mick.
Tellers: Tá, Deputies Emmet Stagg and Paul Kehoe; Níl, Deputies Michael Moynihan and Seán Ó Fearghaíl.
Amendment declared carried.
Question put: "That the motion, as amended, be agreed to."
The Dáil divided: Tá, 99; Níl, 50.

  • Bannon, James.
  • Barry, Tom.
  • Breen, Pat.
  • Bruton, Richard.
  • Burton, Joan.
  • Buttimer, Jerry.
  • Byrne, Catherine.
  • Byrne, Eric.
  • Carey, Joe.
  • Coffey, Paudie.
  • Collins, Áine.
  • Conaghan, Michael.
  • Conlan, Seán.
  • Connaughton, Paul J.
  • Conway, Ciara.
  • Coonan, Noel.
  • Costello, Joe.
  • Coveney, Simon.
  • Creed, Michael.
  • Daly, Jim.
  • Deasy, John.
  • Deenihan, Jimmy.
  • Deering, Pat.
  • Doherty, Regina.
  • Donohoe, Paschal.
  • Dowds, Robert.
  • Doyle, Andrew.
  • Durkan, Bernard J.
  • English, Damien.
  • Farrell, Alan.
  • Feighan, Frank.
  • Ferris, Anne.
  • Fitzgerald, Frances.
  • Fitzpatrick, Peter.
  • Flanagan, Charles.
  • Flanagan, Terence.
  • Gilmore, Eamon.
  • Griffin, Brendan.
  • Hannigan, Dominic.
  • Harrington, Noel.
  • Harris, Simon.
  • Hayes, Tom.
  • Heydon, Martin.
  • Hogan, Phil.
  • Howlin, Brendan.
  • Humphreys, Heather.
  • Humphreys, Kevin.
  • Keating, Derek.
  • Keaveney, Colm.
  • Kehoe, Paul.
  • Kelly, Alan.
  • Kenny, Enda.
  • Kenny, Seán.
  • Kyne, Seán.
  • Lawlor, Anthony.
  • Lynch, Ciarán.
  • Lynch, Kathleen.
  • Lyons, John.
  • McCarthy, Michael.
  • McEntee, Shane.
  • McFadden, Nicky.
  • McGinley, Dinny.
  • McHugh, Joe.
  • McLoughlin, Tony.
  • McNamara, Michael.
  • Maloney, Eamonn.
  • Mathews, Peter.
  • Mitchell, Olivia.
  • Mitchell O'Connor, Mary.
  • Murphy, Dara.
  • Murphy, Eoghan.
  • Nash, Gerald.
  • Neville, Dan.
  • Nolan, Derek.
  • Noonan, Michael.
  • Ó Ríordáin, Aodhán.
  • O'Donnell, Kieran.
  • O'Donovan, Patrick.
  • O'Dowd, Fergus.
  • O'Mahony, John.
  • O'Reilly, Joe.
  • O'Sullivan, Jan.
  • Phelan, Ann.
  • Phelan, John Paul.
  • Quinn, Ruairí.
  • Reilly, James.
  • Ring, Michael.
  • Ryan, Brendan.
  • Sherlock, Sean.
  • Shortall, Róisín.
  • Spring, Arthur.
  • Stagg, Emmet.
  • Stanton, David.
  • Timmins, Billy.
  • Tuffy, Joanna.
  • Twomey, Liam.
  • Wall, Jack.
  • Walsh, Brian.
  • White, Alex.

Níl

  • Adams, Gerry.
  • Boyd Barrett, Richard.
  • Broughan, Thomas P.
  • Browne, John.
  • Calleary, Dara.
  • Collins, Joan.
  • Collins, Niall.
  • Colreavy, Michael.
  • Cowen, Barry.
  • Crowe, Seán.
  • Daly, Clare.
  • Doherty, Pearse.
  • Ellis, Dessie.
  • Ferris, Martin.
  • Flanagan, Luke 'Ming'.
  • Fleming, Sean.
  • Fleming, Tom.
  • Halligan, John.
  • Healy, Seamus.
  • Healy-Rae, Michael.
  • Higgins, Joe.
  • Kelleher, Billy.
  • Kirk, Seamus.
  • Lowry, Michael.
  • Mac Lochlainn, Pádraig.
  • McConalogue, Charlie.
  • McDonald, Mary Lou.
  • McGrath, Finian.
  • McGrath, Mattie.
  • McGrath, Michael.
  • McGuinness, John.
  • McLellan, Sandra.
  • Martin, Micheál.
  • Moynihan, Michael.
  • Murphy, Catherine.
  • Naughten, Denis.
  • Nulty, Patrick.
  • Ó Caoláin, Caoimhghín.
  • Ó Cuív, Éamon.
  • Ó Fearghaíl, Seán.
  • Ó Snodaigh, Aengus.
  • O'Brien, Jonathan.
  • O'Dea, Willie.
  • Pringle, Thomas.
  • Ross, Shane.
  • Smith, Brendan.
  • Stanley, Brian.
  • Tóibín, Peadar.
  • Troy, Robert.
  • Wallace, Mick.
Tellers: Tá, Deputies Emmet Stagg and Paul Kehoe; Níl, Deputies Michael Moynihan and Seán Ó Fearghaíl.
Question declared carried.
The Dáil adjourned at 9.25 p.m. until 10.30 a.m. on Thursday, 20 September 2012.