I call Deputy Michael McGrath on behalf of Fianna Fáil.
Leaders' Questions
Thank you, a Cheann Comhairle. I object to the way you have handled business this morning.
(Interruptions).
Excuse me. Deputy, please resume your seat.
Yes, I will.
Let us be clear about this.
Let us be very clear.
I approached this on the basis of trying to be helpful, so as not to have a row in the Chamber and have people refused the right of reply. I made that decision and made it clear that I would allow a short reply from the Opposition parties.
You did not make that clear at all.
It was to be helpful. That is the reason I called the Deputy, thinking he was going to make a reply to the statement. Let us get that quite clear. There were no games being played. I was trying to be helpful to the Opposition. Now, let us get on with Leaders' Questions.
I will, but I wish to make it clear that our party was not notified there would be statements.
It should have been notified. I understood-----
We were not. You need to take up that issue within your own office, a Cheann Comhairle.
It is not a matter for my office.
It is, because we were not notified.
(Interruptions).
It was never signalled that we would be given an opportunity to make a statement in response to the Minister. That was never made known to us, never communicated. I want to be clear on that.
Please proceed. I will be very slow in future to try to afford opportunities if I am going to face this sort of response.
If only the Ceann Comhairle could do it in a proper way.
I will stick by the rules in future.
Please do. I am delighted to have the opportunity to extend and elaborate on some of the points I made in my opening remarks.
The bottom line is that the selection process for identifying primary care centres on the Government's list was ripped apart by the Minister for Health, Deputy Reilly, as seen in the letter released yesterday under the freedom of information process. He stated he consulted with a whole range of people - except, apparently, the Minister of State in his own Department. He said he consulted, for example, with his Cabinet colleagues. The Taoiseach put it on the record of the Dáil some days ago that the Minister consulted with all his colleagues in that regard. I put a direct question to the Minister for Social Protection, Deputy Burton, some moments ago. Was she consulted on the inclusion of the additional 15 primary care centres as announced by the Minister? Apparently, the Minister for Transport, Tourism and Sport, Deputy Varadkar, was not consulted, because he made his views known on a television programme, commenting that it looked like stroke politics.
The game is well and truly up for the Minister, Deputy Reilly. He brought about the resignation of the chief executive officer of the HSE, lost the CEO of the VHI and has now effectively forced out a Minister of State in his own Department who took a principled stance and was determined that the objectives on health care in the programme for Government would be implemented swiftly, in a fair manner, and in a manner that ensured that scarce resources would be allocated to those most in need. Instead, the Minister, apparently with the full support of all his Cabinet colleagues, rode roughshod over the process whose integrity the former Minister of State, Deputy Shortall, was trying to ensure. Will the Minister, Deputy Burton, state whether she had knowledge of the additional 15 centres being added to the list? Was she included in the process, and is she satisfied about the criteria used by the Minister for Health?
The bottom line is that the former Minister of State, Deputy Shortall, took a principled stand yesterday, but the wrong Minister has resigned. The game is up for the Minister for Health, Deputy Reilly, and the clock is ticking. Will the Minister for Social Protection now put on the record whether she has total confidence in Deputy James Reilly as Minister for Health?
First, in regard to my colleague, Deputy Shortall, I am very sorry and saddened to see her go. That view is obviously shared very strongly in this House by colleagues in both parties.
Deputies
Hear, hear.
Members of the House who are fair will recognise that she is a talented and compassionate woman, a person of very firm resolve, and very ambitious and driven in regard to the political values in which she believes. As colleagues, both of us were elected to the Dáil in 1992, in the aftermath of President Mary Robinson's historic election.
We do not want a history lesson.
She has been my colleague for a very long period.
Will she be your designated leader?
I value her. We were discussing the medical centres and I will return to that. However, in speaking about the scourge of alcohol misuse and drug abuse in this country, Deputy Shortall spoke truth to power. That is the job of every politician, whether in opposition where one has much more leeway, or in government. She did that.
Now she is gone.
She did not get support from the party.
With regard to the Labour Party, I do not know about the relevance of James Connolly-----
James Reilly.
-----to the speakers; I suspect they owe more to people such as Leon Trotsky than they owe to Connolly.
At the time of the last election, the Labour Party went to the people and asked for a mandate - as did the members of the Fine Gael Party - to put this country straight, recover its economic independence and sovereignty and make changes.
That is what the Labour Party signed up to do and what it intends to do. That is what the Labour Party has promised to do for the people of Ireland, as has Fine Gael in terms of Government. Does everybody in Fianna Fáil get on with everybody else every day?
Well Willie?
Does everybody in Sinn Féin get up in the morning and smile-----
(Interruptions).
Does the Minister get on with the Tánaiste?
Politics is about the art of argument, principle, having policies and resolving-----
A Deputy
Does the Minister talk to the Minister, Deputy James Reilly?
-----and bringing people together.
Will the Minister answer some of the questions?
The clock is ticking, Minister, and you have not answered any questions.
The Government is here to do a job on behalf of the people. The people elected the Government to do that.
The Minister has not answered the questions.
As a consequence of the joint work of Deputy Reilly, as the Minister for Health-----
Does the Minister have confidence in him?
-----and Deputy Shortall as Minister of State for GP care, we have a considerable set of achievements. We have the legislation on the A list of the Government's agenda in regard to primary care that will be taken shortly.
That is really helpful to patients.
The Deputies should listen.
Answer the question.
(Interruptions).
Sorry, would Members please desist? Minister, you are over time.
I will conclude on this point. We have now a pipeline of projects in regard to health care centres-----
A pipeline of hot air is all you have.
Deputies, would you please show respect to the speaker? Thank you.
-----which will transform the face of primary care here.
What about the questions, Minister? You are talking down the clock.
We must remember that at the end of the day, and I believe Fianna Fáil shares this view, we will make better use of our health services-----
Will you answer the questions?
-----if we have more people treated at the primary level. The former Minister of State, Deputy Shortall, and the Minister, Deputy Reilly, share that view, as does the rest of this Government.
I will allow one minute for a supplementary question.
Unfortunately, the Minister chose not to answer any of the questions I put, and they were very straightforward questions-----
There were no questions.
-----which required a "Yes" or "No" answer. I will come back to those but this issue is not about people getting on with each other or not getting on with each other. This issue is about the substance of policy, the direction of policy and the manner in which that policy is being implemented. Deputy Shortall had a fundamental disagreement with the Minister, Deputy Reilly, and his Cabinet colleagues on those issues. I ask the Minister again. Is she satisfied with the lack of transparency surrounding the choice of the additional 15 centres? More importantly, and it will be more than pointed if she does not answer this question directly, does she, as Minister, have unequivocal, total confidence in Deputy James Reilly as Minister for Health? She cannot evade that question. Already, she has denied him at least three times. Can she please tell us, "Yes" or "No", if she has confidence in the Minister?
Let me make it clear, as I have done on many occasions, that everybody in the Government has confidence in every other Minister.
This and that.
I have confidence in the Minister, Deputy Reilly. I have confidence in every member of the Government. I have a mandate from the people as a consequence of the last general election to implement the programme for Government.
(Interruptions).
Would you mind allowing the Minister respond?
In terms of the programme for Government, Members should bear in mind that we inherited a difficult situation in health which even the Deputies opposite acknowledge. We are dealing with that and at the end of this process we will have a set of 20 primary care centres throughout this country which will inform the experience of patients-----
Was the Minister consulted on the extra 15?
-----in terms of how to access modern medicine and modern facilities in their own location.
Was she consulted, "Yes" or "No"?
That is an enormous achievement, and we will do that for the people. We have a vision in regard to health and universal health insurance that will put us on a par with other European countries where we will develop a unified health service that will provide for all our people, regardless of their income.
Did the Minister know about the extra 15?
That is the objective of this Government.
I call Deputy McDonald. I ask Members, in the interest of democracy, please to allow the person put the question without interruption and allow the Minister to reply without interruption. Thank you.
Is that a reply?
This has been an interesting session so far.
A Deputy
Does it stop now?
When all of the controversies emerged around the Minister, Deputy Reilly, it was sort of episodic. There was the issue to do with his personal finances, the issue to do with his interest in private medicine, particularly in a private nursing home, the debacle around the €130 million of cuts and so on and it became apparent to me at least that Cabinet would circle the wagons, the backbenchers, probably happily enough in Fine Gael and, with a sense of unease, the Labour Party would join suit, and that the lads would stand by their man.
What is the question?
From what the Minister is saying, she is with them on that. She is standing by her man, Deputy James Reilly, despite the fact that anybody with an ounce of wit could see that the man is not a suitable occupant of that Ministry. That is my first point.
The second point is that the Minister gave an ode to Róisín. She said she is talented, compassionate and ambitious. I have no doubt she is. I suggest that those are all the qualities required for a Minister of State with a brief as critical as the Minister said primary health care is yet Róisín has walked. She is gone, and she has told us the reason. She told us it was because she does not believe there is sufficient commitment to the delivery of the programme for Government in the area of health. We are not speculating about that. That is what she has told us.
Can we have the question now please?
She has further told us that there was not transparency in the decisions around the primary health care centres. We are not speculating; the woman has told us that.
A question please, Deputy.
I put the question to the Minister, and it has been raised with her already. Was she part of the consultation with her man, the Minister, Deputy James Reilly, in respect of diddling the lists-----
What about your man, Gerry?
-----of primary health care centres? Was she part of that discussion? Did she sign up to the additional criteria? Is she satisfied, unlike her colleague, Deputy Shortall, that there was no stroke politics involved and that the criteria were set out and agreed upon? Did she sign off on the addition of these extra primary health care centres?
I appreciate Deputy McDonald's interest in country and western but I am no Tammy Wynette and I do not think she is either in relation to-----
Is it D.I.V.O.R.C.E.?
(Interruptions).
Please, Deputies. Thank you.
Deputy McDonald is challenged occasionally with her own Tammy moments in regard to her own leader and therefore she should deal with that as well.
On the questions about what happened in the Department of Health, and I appreciate Deputy Michael McGrath and Deputy Mary Lou McDonald have not served in Government, the actual detail working out of proposals is a matter for the line Minister. It is extremely unlikely that other Ministers would be involved in the detail other than-----
But he said you were consulted.
Excuse me. I did not say anything.
The Taoiseach said you were.
Deputy McGrath should speak through the Chair.
The Departments normally involved would be the Department of Finance and the Department of Public Expenditure and Reform because it is a matter of public expenditure. Other line Ministers would not be involved in any of the detail on this issue. That is the honest answer.
That is not what he said.
It may have been different in Fianna Fáil. Perhaps everybody came into the room and looked at the list. That did not happen in this case because it is for the line Minister to deal with it, and that is what would have happened. The Deputy is trying to create something that in terms of Cabinet and the way Departments operate does not happen.
The point is that there is a preliminary list of 20 locations and a second list of a further 15 locations-----
Which is Fine Gael's list?
-----which will give us flexibility and options in order to ensure that when we go to GPs and primary health care providers, we will achieve the objective of having a series of centres built on time designed to facilitate the provision of modern primary care services. There may be different views on how that was done and such views are legitimate. However, the way Cabinet government works is that, provided the funding is available via the Departments of Finance and Public Expenditure and Reform, the line Minister makes these decisions. As someone who previously had the honour to serve as a Minister of State in three Departments, I am fully aware of the fact that the line Minister who is, after all, a member of the Cabinet-----
And Fine Gael.
------retains seniority and has responsibility for making final decisions.
The Minister, Deputy James Reilly, referred to intensive and inclusive discussions.
The Deputy had his opportunity. He should refrain from interrupting.
Having said that, I have no intention of disparaging someone who served as a Minister of State. I merely wish to set the record straight with regard to how Cabinet government and individual Departments operate. The critical point is that we must allay the fears of the people who, at a time of very deep economic crisis, are anxious to see investment in primary health care. Everyone is aware that the way to deliver better medical care to people and ensure they have all the necessary tests is to establish modern primary health care centres close to where they live. In the context of that matter, the Minister for Health, Deputy James Reilly, the former Minister of State, Deputy Róisín Shortall, and the rest of the Government are at one.
I suppose that, in spite of herself, the Minister has added clarity to the debate in as much as she has set the record straight.
The Deputy should not refer to clarity. Deputy Gerry Adams is not big on it.
The Minister has informed us that Cabinet colleagues were not consulted in the manner in which the Taoiseach led us to believe they were. The Minister has also indicated that her colleague, the Minister for Public Expenditure and Reform, Deputy Brendan Howlin, was perhaps aware of the details of this matter but that she was not.
(Interruptions).
The Minister, Deputy Brendan Howlin, was not aware of it.
It was Fine Gael's list.
Deputies should address their remarks through the Chair.
I hope the Ceann Comhairle will bear with me, particularly as I did not avail of the opportunity to make a statement earlier.
The Deputy has 27 of the 60 seconds allocated to her remaining.
The reason this matter is so important is that Deputy Róisín Shortall - I presume the Minister for Social Protection will concede the latter knows about Cabinet and high government - has informed us that, to use common parlance, there was "funny business" going on with the list. The Taoiseach absolutely refuted her claim and stated the criteria used had been clear and that Cabinet colleagues had been consulted.
A question please, Deputy.
The Minister for Social Protection has now completely unpicked that version of events. To her credit, she is being honest in that regard. This proves that the stroke or parish pump politics we thought had been consigned to history with the previous Administration are alive and well on the watch of Fine Gael and the Labour Party. What is tragic about this is that it says to people that not only can they not trust Labour Party in government but that said party cannot trust itself in government.
The Deputy-----
We are taking questions.
The Minister for Social Protection has indicated that she has full confidence in the Minister for Health. Deputy Róisín Shortall indicated the same thing last week when she voted confidence in him. However, it appears that the criteria were not clear, that the Labour Party Ministers were not consulted and that the Minister for Health, Deputy James Reilly, went on a solo run. However, those Ministers are now circling the wagons and standing by their man-----
I must ask the Deputy to respect the Chair.
-----irrespective of their party's stated position of transparency and standards in government, which is absolutely shocking.
I reiterate that the Deputy is choosing to misunderstand, which is her privilege.
I fully understand the position.
What the Minister for Health, Deputy James Reilly, said last week actually reflected the process which had been undergone. The then Minister of State was required to draw up the first list of 20 locations. The criteria in this regard were very specific and related to disadvantage and need. The senior Minister added a series of additional locations-----
We know that.
-----in order to reflect further considerations. He is on record as stating this. As is the case in respect of all decisions required on issues of this nature, the Minister then brought the matter to the Cabinet. Deputy Mary Lou McDonald is suggesting everyone in the Cabinet sat down and went through the list. That is not the way it works.
A Deputy
How were the additional 15 locations decided on?
The choice of locations would have been subject to finance being available, which is a major issue. The Minister for Health made the final decision on the matter which was then agreed by the entire Cabinet. However, the entire Cabinet would not, as Deputy Mary Lou McDonald is trying to suggest, be involved in discussing the minutiae and detail of this matter.
I did not say the Cabinet was involved, the Taoiseach said it.
We are over time.
(Interruptions).
The decision on this matter was based on the very important proposals brought forward by Deputy Róisín Shortall, after very careful work on her part in selecting locations on the basis of deprivation and need.
The Minister for Health must be getting very nervous about all of this.
Deputy James Reilly, as the senior Minister, amended and expanded the list in order to provide for sustainability and viability vis-à-vis the proposals in order that all of the relevant health centres would be built within budget and on time, in line with the programme for Government-----
Whose programme is that?
-----and in accordance with the funding available. The key point is that within a relatively short period there is going to be a really important and fundamental addition to primary care services. The success that is going to be achieved in this regard will be a credit to Deputy Róisín Shortall, the Minister for Health, Deputy James Reilly, and the Minister of State at the Department of Health, Deputy Kathleen Lynch, all of the members of the ministerial team who were in place when the decision was made.
Therefore, its a great result all round this week.
Before I begin, I note the Ceann Comhairle's commitment to adhere strictly to the rules of the House in the making of these statements. Those rules are a disgrace.
Perhaps the Deputy might take up that matter with the Committee on Procedure and Privileges.
There are 14 Independent Deputies, comprising a group the same size as that which contains the Sinn Féin Members. However, the 14 Independent Deputies are not recognised in the House and not asked to offer-----
That is a matter for the Committee on Procedure and Privileges.
Those on the Independent benches are paid their salaries like everyone else.
(Interruptions).
When a sizeable proportion of those on the Government benches are gone, we will still be here.
(Interruptions).
This is not democracy.
If Deputy Thomas Pringle wishes to change the rules, he may do so through the Committee on Procedure and Privileges. He should proceed to ask a question.
If this is someone's idea of democracy, it is a disgrace.
We have asked on numerous occasions that the rules be changed. It seems, however, that those in government will not recognise the mandate given to Members on this side of the House.
Exactly.
They will soon do so.
The Minister for Social Protection was certainly handed a poisoned chalice this morning when she was obliged to come before the House to defend the indefensible. It could be stated that to lose one Minister of State is unfortunate but to lose two is certainly careless. I take the opportunity to pay tribute to Deputy Róisín Shortall for taking a courageous decision and for standing by her and her party's policies. Last night she stated the public had a right to expect that decisions on health infrastructure and staffing would be made in the public interest and based on health needs rather than being driven by other concerns.
The question must be asked as to where the Labour Party stands within the Government. When will those in the Labour Party accept that health policy is being led by clientelism and driven towards privatisation by their bosses in government? Primary health care centres such as that at Ballaghaderreen which are not even in the top 200 on the priority list have now been prioritised. These centres are to be delivered by means of public private partnerships, PPPs, which are licences to print money.
I wish to put to the Minister for Social Protection the questions posed by Deputy Róisín Shortall in the House last week. To date, she has clearly refused to answer any of them. Is the Government intent on reforming and strengthening the public health service or does it intend to privatise large parts of it? How will it ensure access to and equity within the health service will be guaranteed? Is this the type of health service the Government wants for the people? In its election manifesto the Labour Party claimed that it would reform the unfair, two-tier health system in order to reduce the cost of delivering care and use the savings realised as a result to extend universal access to essential medical care. Will the Minister for Social Protection inform us now, once and for all, that this promise is dead? How can any other Labour Minister of State hope to deliver on these promises when he or she will not even be able to rely on the support of his or her party leader?
As is the case with every other Member of the House, I respect the Deputy's mandate.
I respect the mandate of every Member of this House. This is my first opportunity to congratulate Deputy Pringle on the events of the weekend concerning Donegal. It is great to see the Deputy here.
I attended two important and well-attended meetings of the Labour Party - the national executive and the general council - whose members are drawn from every part of the country. The party members in both groups discussed health and all the matters facing the Labour Party in government. The Tánaiste and Minister for Foreign Affairs and Trade, Deputy Eamon Gilmore, was fulsome in his support of Deputy Róisín Shortall and fulsome in his commendation of her achievements. Those achievements, both in opposition and as a member of the Government for the past 18 months will still remain when the personality clashes are forgotten and there will be a network of 20 to 35 primary care centres around the country.
I appreciate Deputy Pringle's remarks about public-private partnerships. However, because of Ireland's weak borrowing capacity it is not possible at the moment to have commercially viable PPPs. This is part of the problem and one of the reasons the list would have been expanded in order to provide for more viable options to complete the minimum number of 20 clinics in the timeframe. PPPs in Ireland are not an attractive mechanism to the financial markets at this time. When we get back our economic sovereignty we will be able to borrow and then be in a position to provide all 35 clinics. In the meantime, when negotiating with general practitioners in private practice in all parts of the country, our objective is to ensure that as many citizens as possible in all parts of the country will have access to modern general practitioner facilities which will provide testing facilities, paramedical services, physiotherapy and counselling services, all types of services above and beyond what the traditional GP and practice nurse in a traditional practice setting can provide. This is a significant reform in the provision of health care. Users of the health services or those who help older people to avail of services are well aware of the importance of this achievement. I am confident this will be achieved by this Government and it has been prioritised for spending purposes even when money is tight. In my view, this will be to the credit of the Minister, Deputy Reilly, the former Minister of State, Deputy Shortall and the Minister of State, Deputy Kathleen Lynch.
That was a nice speech from the Minister but it did not answer any of my questions. Deputy Shortall has clearly shown that the emperor has no clothes. On four occasions in public the Tánaiste could not express his support for Deputy Shortall and her stance. It is true that people will have access to primary medical care, provided they are in the Minister's constituency or they have his ear or a clinic has been jumped up the list of more than 200 locations and is included in the top 35.
This Government has been in power for the past 18 months and the Labour Party has not even succeeded in having powers of responsibility delegated to the junior Minister with responsibility for primary care. How can Deputy Shortall's replacement in the Department expect to be able to deliver on any equitable health policy, particularly when he or she will have to deal with a senior Minister who stated last night that pressure is only for tyres? How can junior Ministers deliver? Is there any point in the Labour Party appointing a replacement?
A Deputy
None whatsoever.
Deputy Shortall's replacement is a matter for the leader of the Labour Party, the Tánaiste, Deputy Eamon Gilmore and I am sure he will deal with that matter as quickly as possible. I wish to emphasise again that the outcome of this policy will be a win-win situation for communities right around Ireland -----
(Interruptions).
Sorry, there is no need to get excited.
The life of Reilly here.
At a time of serious economic problems the Government has provided this economic stimulus which it is hoped will put local people to work in the different locations around the country. As economic conditions improve, my hope and my answer to the Deputy's question will be that our ambition is to provide not just 20 centres but 35 centres right around the country. This is a transformative initiative for the health services and that has been Deputy Shortall's achievement. She has provided the basis for getting community care up and running in this country through a network of purpose-built community care centres which will provide the full range-----
Why did she resign?
-----so that people need not go to hospital for tests or have to stay in hospital while undergoing tests because this is where costs are incurred and everyone knows this. That need will be reduced and there will be services on the ground which will allow so much more to be done at a local level.