Leaders' Questions

At last the truth has emerged in the form of substantial and comprehensive freedom of information documents which we received last Friday evening, not through any openness from the Minister, Deputy Reilly, the Taoiseach or the Tánaiste. They reveal how multi-million euro investments in primary care centres were selected by the Minister, Deputy Reilly, who essentially rode roughshod through the diligent and effective work of the former Minister of State, Deputy Shortall, and the HSE. They had previously selected 20 primary care centres in accordance with international criteria, based around the concept of a deprivation index, so that those areas of the country most in need, socially and economically, would get such centres.

The Tánaiste promised me months ago that all documents would be published, even though he refused to do it subsequently. He said that once the documentation emerged it would prove that nothing wrong was done. The decision of the Minister for Health, Deputy Reilly, was supported by Minister after Minister, with the exception of the Minister of State, Deputy Shortall, who took a principled stand. Knowing the chicanery that was going on behind the scenes, she resigned in opposition to the actions of the Minister, Deputy Reilly, and of her fellow Ministers.

Freedom of information requests reveal a shambolic and chaotic decision-making process by the Minister, Deputy Reilly, particularly on the night before the decision was taken and the Cabinet meeting itself. One should note the timeline. On 16 July at 8 p.m., health officials e-mailed the Department of Public Expenditure and Reform attaching the Department’s final list. The list had grown to 35, south Dublin had come off the list and Swords and Balbriggan - both in the Minister’s Dublin North constituency - had been added, along with Oranmore. Swords ranked 130th on the earlier list of the then Minister of State, Deputy Shortall, while Balbriggan ranked 44th. The Cabinet meeting was on 17 July. Health officials informed the Department of Public Expenditure and Reform that “there are changes to last night’s list”. Castlecomer and Oranmore were no longer on the list, while Ballaghaderreen and Kilkenny had been added.

Does the Taoiseach accept the observation of the then Minister of State, Deputy Shortall, that this documentation gives the lie to the excuses and justifications offered by the Minister, Deputy Reilly, on the selection of the sites? Does the Taoiseach also accept that the Minister got it wrong - and that he and the Tánaiste got it wrong in supporting such a decision-making process, which was by any standards of objective observation a poor performance and wrong decision by the Minister on the selection of the sites which are commercially valuable and important in terms of multi-million euro investments?

No, I do not accept that at all. I note Deputy Martin’s concern about the former Minister of State, Deputy Shortall. It is great that he would show such concern for a person who made a decision to retire as a Minister of State with responsibility for health.

I said she resigned.

Deputies

She resigned.

I thought Deputy Martin would be far more interested in seeing that foundations are cut, that people are employed in building primary care centres-----

-----that GPs buy into them and that we proceed to develop a substantial number of them around the country to provide decent primary care facilities for patients in need of them.

What about Oranmore?

And Castlecomer.

That is where Deputy Martin’s interest should lie. It ill behoves him to come to the House and refer to this matter when he was party to a list on the back of an envelope of 53 towns - without any consultation whatsoever, good, bad or indifferent - for decentralisation, with signs already up around the country about particular people saying that offices were coming to their parts of country.

As Deputy Martin is aware, the criteria used were the deprivation index, the service priority identified by each service in the local health office in the integrated service area and the accommodation assessment. The Minister added in additional criteria such as competition, GP co-operation, the GP-to-population ratio, existing health facilities, pressures on services and particularly acute services, funding options including Exchequer-funded build and lease, and the implementability of public private partnerships. Deputy Martin is aware that there are three possible options: direct investment through the Exchequer from the HSE, the lease option, under which centres would be built by builders and leased to the HSE, and the PPP option, in so far as the economic stimulus package announced by the Minister, Deputy Howlin, is concerned. In that sense the Minister was absolutely correct. Instead of having just a list of 20, in order to get competition and buy-in from general practitioners it was necessary to have more than 20 so that those that did not get across the line, as it were, or those about which there were objections or non-facilitation by GPs could be moved off the list and provision made to build 20 of them under the PPP process. I assume that over the lifetime of the Government at least 80 or 85 primary care centres will be built or provided under the three options I have outlined for Deputy Martin. We need more than 150 primary care centres around the country. Looking at the original HSE list of 227, Deputy Martin himself would acknowledge that is difficult to see how No. 1 differs from No. 59 or No. 98 because all of those factors are required. I am far more interested in getting on with the job of seeing the buildings take shape and providing facilities for patients all over the country.

The Taoiseach is correct to say that I have shown concern about the position adopted by the then Minister of State, Deputy Shortall. The public is concerned about how she was treated. People are equally worried about the lack of concern emanating from the Taoiseach and Deputy Shortall’s party leader, the Tánaiste, about her situation. The public has one basic question: how is it that the Minister who was playing by the rules, who spent 20 months drawing up criteria with the HSE and going through the process meticulously and in a detailed, transparent and objective way, got shafted overnight and had to resign? That is what concerns the public - that the person who took a principled stand in support of communities that her party aspires to support, whose decision-making process was ridden roughshod over, was the person who had to resign. That is why people are extremely concerned.

The Taoiseach referred to various criteria such as GP co-operation, funding options and PPPs. I have in my hands the documentation we received and there is no mention of any of that. For God’s sake, will the Taoiseach stop the pretence? He must stop pretending there were criteria behind the decisions. There were no criteria behind the Minister’s selection of the sites, and it is downright dishonest to suggest that there were because I cannot find them in the documentation. Nobody can. No one has been able to find them for the past three or four months-----

They are not there.

-----despite all the talk of openness and transparency. The PPPs in question involve a collective investment of €115 million. It is equivalent to a tendering operation. Ministers should not be next nor near such a process. It should be a stand-alone process because there are many consortiums all over the country that would like to think, if they are making submissions, that the system is fair, open and transparent. By any yardstick, the system was not fair, open or transparent.

I have outlined for Deputy Martin the three options that are available.

What about Oranmore?

There is direct funding through the HSE from the Exchequer; there is a lease operation whereby the centres are built by providers and contractors; and there is the PPP system. The Minister has already confirmed on a number of occasions in the House the criteria that were set out for the selection of the locations. He endorsed that by speaking about Balbriggan in particular, in which there was a clear danger that the lease option would fall through. In that respect the town was clearly identified as a location for a primary care centre and it was put on the list. As it happened, the lease was finalised and the centre will go ahead separately from the PPP option. On 9 October a report was issued to the Secretary General of the Department of Health by the internal audit unit which clarified for him that there was no connection between the Minister, Deputy Reilly, and the selection of the site or persons related to it.

I came across information recently in which somebody said, after two and a half years in the former Department of Health and Children, and that it took longer to get things off the ground in that Department than in other Departments. The person said that he had just formulated a new health strategy for the next ten years and that he would like to oversee its early implementation. That person was the former Minister, Deputy Micheál Martin, who was at that time in charge of the Department of Health and Children. He was very up-front about difficulties in the Department. When he was in charge of the Department of Health and Children - perhaps he does not remember-----

He was never in charge of the Department.

-----he managed it so well that the Department had to be bailed out with supplementary budgets amounting to more than €664 million. It ill behoves him to come to the House-----

That was over five years. This Government did it in one. A total of €350 million was required in one year.

(Interruptions).

I remind Deputy Martin as well that he said he would end waiting lists forever in two years’ time-----

The Taoiseach nearly did it in one. He is some boy.

The Taoiseach should give us his quote on Roscommon while he is at it.

-----and when he was asked whether he would be prepared to stand over that, he laughed at the reporter in question.

The Taoiseach should defend his Minister.

Deputy Martin must not come to the House saying he has the answers to every issue that arises.

I would say the Minister is for the chop. The Taoiseach is not giving him any backing today. He is looking shaky.

The Deputy left an unholy mess behind. This is part of clearing it up.

He is a Messiah. He will clear it up.

Under these three methods I want to see primary care centres-----

This is shambolic. There are no three methods.

Have you any job in Europe for him?

-----being built, opened and used by people, thereby offering proper provision of primary care facilities throughout the country.

Send him off to Europe.

We have many more than 20 to build.

What did the people of Oranmore do to the Taoiseach?

Phil Hogan wanted Kilkenny. There was one for everybody in the audience at the end.

Please show respect to Deputy McDonald.

The list of calamities around the Minister for Health, Deputy James Reilly, continues to grow. At the weekend hundreds of people took to the streets of Castlebar, in the Taoiseach's constituency, to protest against the Minister's decision to cut home help hours. The Minister of State, Deputy Jan O'Sullivan, is on record as saying these cuts are not right. She made those remarks in response to the situation of Catherine Brosnan, who has had home help hours cut for her son, Christopher, who suffers from cerebral palsy. Catherine Brosnan is not alone. Very many parents throughout the State who have children with severe disabilities have seen their service cut or taken away entirely.

At the weekend there were the further revelations that the Minister unilaterally had added new locations in his constituency to the primary care centre list-----

Which subject is the Deputy discussing?

-----the evening before the announcement was made. For the past 18 months, the Minister has had a track record of unmitigated disaster. He closed public nursing homes while being up to his neck in the private nursing sector. He promised he would make savings in the areas of consultant contracts and generic drugs, and would recoup costs for private beds in public hospitals. Worse, he has imposed savage cuts on the most vulnerable in society.

What is your question, Deputy?

He mishandled the demands of the family of Savita Halappanavar in regard to an inquiry.

I do not believe the Deputy heard me. I asked the subject matter she was discussing.

I am addressing the track record of the Minister.

No. This is Leaders' Questions.

Allow me to put my question.

The Deputy put a question to the Taoiseach and had two minutes to do it. She is over time.

The Minister's explanations in regard to the primary care centres are ludicrous and do not stand up to any scrutiny. Everybody knows that the position of the Minister, Deputy Reilly, is untenable. The dogs on the street know this. When will the Taoiseach come to this realisation and relieve Deputy Reilly from his position as Minister for Health?

The Deputy is perfectly entitled to join her colleagues on that side of the House in tabling a motion four months in advance of being able to move it - if she wants to follow the shallow road of popularity.

In any Department there are difficulties and they will continue. The Minister for Health has taken on the task of cleaning up the most unholy departmental mess left behind by an outfit that put together all the health boards and imposed the superstructure of the HSE, which was palpably and patently unworkable. To make these changes in a time of enormous economic challenge is never easy. The cost base of the health system in this country is exceptionally high and this issue will continue to be dealt with. I commend those people working in the health system who have already made serious changes to the way they do their business, in rosters and implementing and maintaining front-line services under difficult circumstances. Nobody denies this.

The people who marched in Castlebar at the weekend-----

Did you meet them?

-----were very welcome and have every right to make a legitimate protest. I met the bogcutters in Loughrea the other night and they are also entitled to protest-----

A Deputy

Was Luke there?

-----as are other people who want to walk on the streets in regard to any concern they may have. However, as I told the people in Loughrea, they are not entitled to block the public road when people are going about their legitimate business.

The Minister, Deputy Reilly, has set out his strategy for dealing with the health system, namely, by changing the structures to bring about a situation where there will be universal health insurance and where the effort of everybody working in the health service will be to do more with less, as is happening. The idea is to bring about a situation where there will be health services across the board for young and old alike of which we can be proud. We have a long way to go on this. The Deputy has not made any constructive suggestion other than to mention dismissal of a Minister.

Very constructive.

In this country people usually decry lay people for their failures in finance or any other departmental area but when there finally is somebody who understands medical politics and has a clear strategy for where we should aim and be, he too is decried. I do not claim we are all perfect. We all make mistakes. However, the responsibilities of the Minister, Deputy Reilly, and the Ministers of State, Deputy Alex White and Deputy Kathleen Lynch, are such that they are the trio leading the enormously difficult changes in the Department of Health at a very challenging time. I commend them for their efforts.

This is not easy; it is difficult for many people. I asked the person who has responsibility for home helps in the western area how he is implementing these reductions. His perspective was that he eliminated any reduction in service to those who had to use hoists, were on palliative care or those who had only one hour's home help. Where there is a medical requirement for such a service it will continue to be given. It is not easy and is not as flúirseach as we would wish but changes must be made in the interest of getting this right for everybody and for the future.

It is not easy, certainly not for those people who are on the receiving end of what the Taoiseach called the strategy of the Minister. The families who are being hurt directly in the here and now by his cuts to home help hours are living a terrible reality and the Taoiseach appears to be either immune or indifferent to that reality. The Minister has a responsibility. He has a duty of care to citizens and a responsibility to act in a transparent, fair and accountable way but has done nothing of the sort. His actions in respect of the primary health care centres are the kind of stroke politics-----

Can I have the Deputy's supplementary question, please?

-----that Fianna Fáil perfected over many years. He now follows in that dishonourable tradition. I do not choose to personalise this against an individual. I am saying very clearly that in Deputy James Reilly we have a Minister-----

What is the Deputy's supplementary question?

-----whose strategy is failing and who fails to meet even the most basic criteria-----

This is not speech time. The Deputy is not listening to me.

-----of openness and good governance.

Will she please give me her supplementary question?

I can only presume that just as the Minister told us yesterday if he had it all to do again he would do it again in the same way, the Taoiseach is standing by him and is refusing to take any action.

Please put your supplementary question.

I reiterate my question. What will the Taoiseach do about his Minister for Health in a scenario where he is so abjectly failing and where public confidence in him is so clearly lacking?

Before the Taoiseach takes his place, I want to read the following for the information of the House:

Under Standing Order 27 - which deals with Leaders' Questions - at the commencement of public business on Tuesdays and Wednesdays, the Ceann Comhairle may permit, at his or her discretion, a brief question not exceeding two minutes from each leader in opposition to the Taoiseach about a matter of topical public importance in respect of which the following arrangements will apply.

The order then deals with the time limits, namely, two minutes for asking the question, three minutes to reply and a minute's supplementary which shall be brief.

Will those responsible for asking Leaders' Questions please adhere to the standing order?

Allow the Taoiseach to reply.

I do not want to have to interrupt people on a continuous basis. A habit is growing in the House of asking multiple questions in one, which is not allowed and will not be permitted. I will not repeat this warning. Please respect the Chair or get the Whips to discuss the matter. If people want to change the Standing Orders let them do so but I have to apply the orders as they read.

I thank the Ceann Comhairle for that clarification. I thought Deputy McDonald would welcome that Government is in a position to make announcements about the provision of primary care centres. I gave Deputy Martin the three headings that apply: direct funding, leasing arrangements and public private partnerships.

The decision in respect of public private partnerships is very clear. If there were only 20 centres on the list, we would run the clear risk of general practitioners not buying in to facilitating the servicing of their primary care centres were they to be built. This was the position at a number of locations throughout the country.

I would have thought that what we are doing here, which is part of the economic stimulus of €2.5 billion announced by the Minister for Public Expenditure and Reform and relating to health, roads, education, justice and the major development that will be the Grangegorman centre, would be welcome. Deputy McDonald will understand that while there are 35 centres on the list, only 20 will proceed to be developed by means of public private partnerships. It is those 20 in respect of which there is competition, buy in and planning permission. In addition, all of the conditions are being measured up to in the context of these centres in order that the final 20 can be got across the line. It is not a case of stating that the 35 centres will be built, one after another. Some 20 centres that can be commenced and completed will be bundled together and will proceed by means of public private partnerships.

I do not welcome the reduction in home help hours. Neither do I welcome the Taoiseach's support for a Minister who proposes such cuts.

I would have thought that even the Deputy would have welcomed that, particularly as she is a member of a party which was involved in closing 800 long-stay beds in Northern Ireland.

Will the Taoiseach consider sending a note of congratulations to the Greek Prime Minister, Mr. Antonis Samaras, on the stroke he pulled last night in having an enormous amount of Greece's debt implicitly written off? Indeed, Mr. Samaras described the deal as a great victory. It is time Ireland was in a position to claim - in the context of its own debt negotiations - a great victory. We have one important thing in common with the Greeks, namely, we both have unsustainable levels of debt. The Greeks seem to have worked this to their advantage but we seem to find it very difficult to do so. While Greece celebrates this great deal today, we sit on the sidelines as spectators.

Did the Taoiseach hear the chairperson of the Economic and Monetary Affairs Committee of the European Union state on "Morning Ireland" that, in light of the Greek deal, Ireland had been left with a raw deal on the promissory notes relating to the former Anglo Irish Bank? I understand the Taoiseach's refusal to accept advice from this side of the House to the effect that he should take unilateral action in respect of the Anglo deal. When such advice is offered by impartial and key individuals from within the European Union, however, it is time he listened. The deal done last night was spectacular and it implicitly writes off some of the Greek debt in the period 2016 to 2020. It will also will give the Greeks interest rates on some of their loans of 50 basis points, which is virtually nothing, and extends those loans. This is something which we have completely and utterly failed to achieve.

What does Greece have that Ireland does not have?

Greece has eyeballed the EU and the IMF and we have not managed to do so.

(Interruptions).

Greece lightning.

Please allow Deputy Ross to complete his questions.

In light of the Greek deal, is the Taoiseach prepared to tell the European Union, the European Commission and the IMF that we will not be paying the promissory notes on 31 March next? If he did so, those entities would listen to us in the same way they listened to Greece last night.

How is the Deputy's tour going?

Or indeed the way people are encouraged to pay €25 to see the Deputy play a scripted role at the Bord Gáis Éireann Theatre.

I freely paid for my ticket.

(Interruptions).

Some tickets only cost a fiver.

(Interruptions).

May we please revert to Leader's Questions?

We call shows like the one in question bucket meetings.

The Taoiseach has some-----

Pay up. I do not know whether the show in question is a rewriting of a certain script and should be called "Four Angry Men".

There are two complementary tickets left if the Taoiseach wants them.

The position today is somewhat different from that which obtained some months ago when it was stated that Greece would default-----

It did not have to do so.

It defaulted last night.

-----that it would be driven out of the euro and that there would be a catastrophic situation here as a result. What we are discussing here is a decision that was made by eurozone Ministers which is designed to ensure that Greece will maintain its position as a member of the eurozone and will be able to work its way out of its difficulties. The position of Greece is entirely different from those of Ireland and Portugal.

Deputy Mathews has a different view.

We have separated those positions in the past 12 months and it is recognised across the world that Greece is in a completely different position to Ireland. Deputy Ross inquired as to what Greece has which Ireland does not. The tax-free threshold there has been lowered from €12,000 to €5,000. A married couple with only one earner in Ireland only enters the income tax net at €25,750-----

(Interruptions).

-----and a single person does so at €16,500. The number of public sector job cuts in Greece will be 150,000 by 2015. Any public service reductions here were done on a voluntary basis. Monthly pensions above €1,000 in Greece will be cut by 20%, the minimum wage is being cut by 20%-----

Answer the question.

-----from €751 to €600 per month. The Greek Government is obliged to raise €11 billion through privatisation by 2016. This money will solely be used to pay down debt.

That is a boomerang.

The attendance of the Minister for Finance at yesterday's meeting in Brussels means that the decision that was made will not mean-----

What are we going to get out of it? A hearing. Ráiméis.

-----that Ireland will be a contributor in so far as Greece is concerned.

Deputy Ross will be aware that we contributed over €350 million in bilateral loans. We will not be required to return profits or interest in this regard. That is a recognition of the very different situation in which Greece finds itself.

For the Deputy's information, let me repeat that a great deal of work is taking place in terms of the preparation for the legal framework as a consequence of the decision on 29 June-----

Live horse and you will get grass.

-----to sever the link between sovereign and bank debt and in respect of the promissory notes with the ECB. It is the intention of the Minister for Finance, on behalf of the Government, not to have to pay the €3 billion that is due in March 2013. It is in this regard that discussions are continuing to take place with the European Central Bank. I noted Deputy Martin's comments on the conclusion of the European Council report to the effect that these are things which could be restructured quite easily. That is a bit Irish coming from a member of the Government which made the most extraordinary economic decision ever foisted onto the Irish people.

The Minister beside the Taoiseach has had a few Irish moments of his own.

Why did the Taoiseach and his party vote in favour of that decision?

(Interruptions).

It takes time, diligence and patience in order to obtain a sense of trust, confidence and belief from others to the effect that they should help us.

If the Taoiseach listened to his party's banking expert, we would be in a completely different position. Deputy Mathews is a man of integrity.

That recognition has been achieved and we will continue with the discussions in order to bring about a situation where the level of debt to which Deputy Ross refers can be re-engineered in the country's interests.

I call Deputy Ross and ask for some order so that he might pose a question.

I thank the Ceann Comhairle.

Deputy Ross is one of the four angry booksellers.

My request applies to Members on both sides of the House.

How many tickets would the Minister for Communications, Energy and Natural Resources, Deputy Rabbitte, like for the show?

Deputy Ross is the most unlikely angry young man I have ever come across.

I have called Deputy Ross.

Those on the Government benches are seeking free tickets.

I wish to respond in the first instance to Deputy Rabbitte for offering tickets to-----

The Deputy will not respond to him.

I assure the Minister, Deputy Rabbitte, that there is a bigger audience at the Bord Gáis Éireann Theatre than there is here.

Yes, but we have heard what Deputy Ross has to say before.

Deputy Ross and his colleagues are having their own little version of The Gathering.

Deputy Ross has 45 seconds left in which to pose a question.

The difficulty is that we refer to Greece as occupying a special position and to Ireland also occupying such a position. Greece's special position has gained it some unique concessions. Will the Taoiseach indicate whether he regards - I would like to hear a specific reply on this - Ireland's debt as unsustainable?

Second, as a result, will the Taoiseach look for the same terms as Greece and not just park the Anglo Irish Bank promissory note? Will he now declare that we are not paying it? He was nearly there in what he said. Will he declare that Ireland will not be paying it on 31 March 2013?

The intent of the Government is to achieve agreement on a re-engineering of the promissory note relating to the former Anglo Irish Bank. It could be regarded as the replacement of a bank overdraft with a very long-term mortgage. That is the context for the discussions between the Minister for Finance and his officials and the European Central Bank with a view to arriving at a situation where we would not have to pay €3 billion in March 2013. We said before-----

Will the Government refuse to pay?

Discussions are continuing with the European Central Bank. The Deputy will have heard the public comments by other political leaders, other Ministers for Finance, the European Commission and the IMF. There is an understanding of the very great challenge placed on the backs of Irish taxpayers. We want this to be understood. The objective of the Government is to bring about a re-engineering of that level of debt before March 2013. This objective is the subject of much discussion and I hope it can be achieved in the interests of the people and the country. It is well recognised that since Ireland was first out of the gate, a very significant burden was placed on the people. It is a case of following through on that recognition to arrive at a decision in the interests of the country. What happened in Greece provides a menu of decisions made about the situation in Greece.

It is not a bad menu and they get to have dessert too.

That menu is there for all to see and examine. Ireland is in a different space in this regard. However, there is a general understanding of what has been done in the case of Greece. Our discussions are about a concession in a different area, a re-engineering of the promissory notes.