Leaders' Questions

Over the past several months, particularly over the past several weeks, we have been led to believe that a deal to restructure the promissory notes was all but done. We on this side of the House support the need for a restructuring of our bank debt. As the Taoiseach said in Paris before Christmas: "Ireland was the first and only country which had a European position imposed upon it, in the sense that there was not the opportunity if the Government wished to do it their way by burning bondholders." In essence, the Taoiseach said Ireland showed solidarity to prevent the risk of contagion at the time which now needs to be reciprocated.

In addition, many media commentators felt a deal was clearly on the cards over the last while. To be fair to all of those concerned, the leaks and the usually well-informed sources certainly led people to come to such a conclusion. However, if it was not for Reuters we would probably have the same view today. The Government did not indicate all along, and certainly not last week, that there was any setback or any significant challenge particularly in the context of the European Central Bank, ECB, meetings. It was Reuters that revealed on Friday evening that the ECB did not accept an Irish Government proposal, claiming it was contrary to EU treaty law. Will the Taoiseach comment on this? Will he specifically outline to the House the Government's proposal to the ECB on the promissory notes?

At this stage we need transparency. The Government has been negotiating for the past 18 months. There seems to be a lack of willingness to communicate the facts about the progress made, or otherwise, in the basic request the country has made to the ECB. How many ECB meetings are left where this issue will be considered? Will the Taoiseach indicate the impact any such deal will have on next year's budget? The Tánaiste escalated the rhetoric several days ago when he told Latin American leaders meeting their European counterparts that any failure to arrive at a deal would be catastrophic. Will the Taoiseach explain what the Tánaiste meant by "catastrophic"?

I have been very clear and consistent about this since the negotiations and discussions with the European Central Bank began. The Government and the Governor of the Central Bank, who attends the meetings as a member from Ireland, have made it perfectly clear that this is not an easy situation to unravel. Clearly, the untangling of the deal done, which will cost €3.1 billion per year until 2023 and lesser amounts beyond and which amounts to almost €48 billion under the current arrangement, is not simple. If this were a simple issue to untangle, it would have been done long ago; if it were not as complicated as it is, then it would have been dealt with long ago. I have said consistently that what the Government wants is the best outcome that can be got for the taxpayer.

During complex and technical negotiations on a range of issues many matters are discussed. I want, and I am confident that we will have, a conclusion and a deal on this before the next payment date, which is due at the end of March. Deputy Martin said there were no significant challenges but there are and they are very significant, technical and complex.

I did not say that.

Deputy Martin said it in his comment just now. I wrote it down. He referred to significant challenges. Clearly, there are significant challenges.

I am asking "What are they?"

In any event, I put it to Deputy Martin that the general focus of these discussions has been about the range of options with regard to the promissory notes, the sources of funding, the duration of the notes, the interest rates applicable and all of that area. I have been clear in saying that we want to restructure and re-engineer this situation effectively to move from a high interest rate overdraft to a long-term, low-interest mortgage. It is within these parameters that we want to get the best possible deal for our taxpayers. The discussions have not concluded and I expect that we will have a conclusion by the next payment date, which is at the end of March.

I have no function and neither does the Government in calling European Central Bank meetings. It is a matter for the chairman and chief executive when they wish to call them. The Governor of the Central Bank attends those meetings.

What would the impact be? Clearly, it would make the debt sustainability more easy to deal with from an Irish perspective. It would strengthen the international view of Ireland making progress towards an exit from our programme. It is in these areas where we wish to get the best deal for the taxpayer here.

I am no wiser about the questions I asked. It is time for a little more transparency in terms of what is being asked. People are interested. They have been hearing for some time that a deal is certainly on the cards and will be concluded but no one has any idea what kind of deal is being discussed. Ultimately, when a deal arrives, will it be the real deal the Taoiseach was looking for or will it be some watered down deal that emerges from the discussions with the European Central Bank? In essence, can the Taoiseach confirm that the European Central Bank is up for separating bank debt from sovereign debt? Is it committed to the game-changer decision, so described by the Tánaiste following the June summit last year? I would appreciate if the Taoiseach could elaborate.

Some one and a half years ago or perhaps less I put it to the House and I wrote to the Taoiseach suggesting that we join up. I suggested that we would be willing to support the Government and that all sides of the House, as the Oireachtas, could communicate a unified message to Europe in terms of the need for such restructuring. On that occasion the Taoiseach declined and suggested that perhaps the strands of opinion in the House were such that they would not command a uniformed response or position. I put it to the Taoiseach that I offered that in a constructive spirit in terms of the Oireachtas making a clear statement supporting the need for restructuring. I asked about the impact and the Taoiseach gave some indication in terms of the sustainability of our debt and programme. Does the Taoiseach envisage an impact of the deal in practical terms and in terms of the actual figures to be brought forward by the Minister for Finance in next year's budget? Some people have suggested that the deal on the table last week could have realised €1 billion in savings and that such would be the impact on the budgetary figures next year. Will the Taoiseach confirm that or will he give his ballpark figure for what a deal could mean in practical terms for the people and their household day-to-day activities in terms of budgeting, savings, cutbacks and so forth?

The discussions taking place at the ECB are about the source of the funding, the duration of the notes, the interest rates applicable, the implications for a wider bank debt deal and the implications and options arising from it in respect of the financial system. In respect of the deal done by the previous Administration on the promissory notes, the unified message which we have been sending clearly to Europe and in respect of which there has been powerful support from the Commission, the Council, the European Parliament and the IMF is that: first, it is unfair; second, it needs to be restructured and re-engineered; third, it would ease our debt burden in respect of the requirement to fork out €3.1 billion each March for ten years; fourth, it would strengthen market intent and reflect better on Ireland as a place that is open for business and a most suitable location for further investment; and fifth, it would help to ease our exit from the programme. We have been upfront about that and these five points are messages that anyone in the Oireachtas who would wish to support the measures could convey.

The detail of this is very complex and technical. Deputy Martin has referred on several occasions here following meetings of the European Council that it could be restructured quite easily. I assure Deputy Martin that if that were the case it would have been done long ago.

The Taoiseach keeps saying that but I never said it.

With regard to the decision of 29 June to break the link between sovereign debt and bank debt, following that on the single supervisory mechanism, the ECOFIN group started its discussions on this matter. When the matter of an extension of the mortgage situation for Portugal and Ireland in the same way as that applied to Greece was raised, the principle was accepted and it went to the working group for further consideration. If that is to happen, it would be separate from the recapitalisation discussions. I imagine it would be worth more than the figure mentioned by Deputy Martin but I would rather not put a figure on it. The important thing is the acceptance of the principle and the discussions that will follow. Clearly, if it is agreed and it can be followed through, it will be of substantial benefit to the country.

What did he mean by "catastrophic"?

We need a debate on the promissory note negotiations, a promissory note, the House will recall, which was created by Fianna Fáil and which the people cannot afford to pay.

I wish to put to the Taoiseach another question which I hope he will be able to answer clearly. Due to some intrepid work by journalists, who used freedom of information requests, we learned that hospital upgrades were fast-tracked by the Minister for Health, Deputy James Reilly, at the behest of the Minister for Public Expenditure and Reform, Deputy Brendan Howlin, and the Minister for the Environment, Community and Local Government, Deputy Phil Hogan, in their respective constituencies ahead of other hospitals upgrades and capital works in hospitals throughout the State.

No one in Sinn Féin begrudges the people of Kilkenny, Carlow or Wexford their hospital services. There are other priorities in the region, including the need for a palliative care centre for the south east. However, the Labour Party Minister for Public Expenditure and Reform, Deputy Brendan Howlin, authorised the €12 million budget for the Wexford hospital upgrade without reference to the HSE board, which was only informed of these decisions one month after they were announced by the Ministers. The Government has downgraded hospitals in Dundalk, Navan, Ennis, Nenagh and elsewhere and it has broken promises to restore accident and emergency services to hospitals in Roscommon and Monaghan.

The problem with the Government, like the Fianna Fáil Government before it, is that there is no real transparency in Fine Gael and Labour Party decisions. The Taoiseach will recall the famous programme for Government in which he committed to openness and transparency, but the decisions about these two hospitals, like the decisions of the Minister, Deputy Reilly, on primary care centres, were only revealed because journalists and Deputies asked questions. How long will the Taoiseach allow the Minister, Deputy Reilly, to act in breach of his commitments in the programme for Government and in complete conflict with the public interest?

If any other Government did it, there would be war.

These projects have been in the pipeline since 2006. Deputy Adams will be aware that it is now 2013.

Bring home the bacon.

The Wexford General Hospital accident and emergency unit operated out of a converted pharmacy. I do not know if Deputy Adams considers that suitable or whether he thinks it should continue in that situation. At St. Luke's General Hospital in Kilkenny, accident and emergency has operated from a portakabin since 2000. Any public representative will understand that these are major hospitals which have had commitments for support from everybody in getting on with the provision of these facilities, which are part of the restructuring of the health system to ensure that patients have the best facilities available to them for their treatment. In 2006, the then Minister for Health and Children stood over here and described the fact that people were waiting on trolleys as a national emergency and said the situation was unacceptable. It was. The party that was then in the majority, Fianna Fáil, said it would take urgent action, but both projects have languished on the capital programme since then.

Clearly, since this Government was appointed, waiting times have reduced significantly, while critical hospital infrastructure has been prioritised.

The project in Wexford comprises an emergency department, including a maternity delivery suite and a theatre with necessary equipment, with a main entrance. The project is under construction and good progress is being made. Do not deny that to the people of Wexford. What we want is to see more of such developments as quickly as possible in the interests of patients. The project is expected to be completed in 2014. To date, €2.5 million has been expended.

When is the Limerick project commencing?

The St. Luke's hospital project comprises an emergency department, a medical assessment unit and a unit for day services, including endoscopy. Construction commenced in 2012 and the facilities are expected to be completed and operational by 2014. To the end of 2012, €1 million has been spent.

Deputy Adams should consider the outcome. Instead of having more reports, more capital programmes and more proposals sitting on shelves while nothing happens, it is about time we moved, with as much urgency as we can, to put blocks and concrete in place and make facilities available for the taxpayer - in this case, those in Kilkenny and Wexford who need these facilities, which have been operating out of portakabins since 2000 and 2002, respectively. These capital works were approved in the programme by the HSE and it is past time we got on with this. We must look at the outcome, which is of great benefit to the people of Wexford and Kilkenny.

That is disingenuous.

Deputy Mary Lou McDonald is shaking her head. If she does not want these facilities made available to patients in those counties, she should stand up and say so.

Of course the people of Wexford, Kilkenny and Carlow and every other county deserve the very best hospital services. The Taoiseach is being disingenuous. The question I asked was on the transparency and accountability of Government decisions. It is not long since the Taoiseach's predecessors were boasting about how ministerial office brought benefits to their own particular constituencies. It was seen as acceptable and reported as such. There used to be speculation in the media about the benefits a ministerial appointment would bring to a particular constituency. That is now seen as wrong and as bad politics. We have had the spectacle of a Labour Party Minister of State resigning over such politics while a serving Labour Party Minister engages in strokes. The Taoiseach's Minister for Health is central to it all. I admire the Taoiseach's loyalty to the Minister.

Deputy Adams was let down.

I am looking for the transparency and accountability referred to in the programme for Government. The Taoiseach has failed to provide a credible explanation as to why these hospitals, which obviously deserve to be upgraded, were fast-tracked. What were the criteria? What was the basis? Where is the record of the decisions? Why was the HSE not told until after the Ministers had made the announcements?

In the supplementary budget of 2009, the HSE's capital allocation was reduced by 32%. As a consequence, certain capital projects were deferred, or paused, as they like to call it in official terms. The Wexford and St. Luke's hospital projects were among those deferred. Despite the previous Minister's statement that urgent action was being taken and that the situation was unacceptable, the reality is that they were paused.

In 2011, planning permission was in place for both locations and both projects had reached the detailed design stage. As it happens, in 2011, the Minister for Health, Deputy Reilly, made it crystal clear that his initial priority was to reduce the number of patients on trolleys, as set out in his policy on transforming the structure of health services delivery. As Deputies are aware, the Minister established the special development unit to tackle the scandalous situation at accident and emergency units throughout Ireland. In case Deputy Adams did not hear me the first time, I repeat that the medical assessment unit at St. Luke's hospital in Kilkenny has operated from a portakabin since 2000, while the emergency department at Wexford General Hospital has operated from a converted pharmacy.

(Interruptions).

Deputy Mac Lochlainn may think that is acceptable. However, I am sure he was very happy to see the scale of investment in the accident and emergency unit at Letterkenny General Hospital, which the people up there were perfectly entitled to.

Free the portakabin two.

Instead of persisting in the witch hunt of the Minister for Health, Deputy Reilly, and other Ministers - I understand the politics of that-----

(Interruptions).

I am much more interested in the outcome, in terms of bricks and mortar, facilities, equipment and professional staff to give patients in Kilkenny and Wexford the very best level of attention.

The Minister is tougher than that.

A number of major hospital projects in the south were delivered under budget in 2011, and efficiencies were achieved. That enabled the Kilkenny project to be accelerated, while additional funding of €12 million was made available for the facilities in Wexford.

The Taoiseach is embarrassing himself.

I supported that in opposition and I support it now.

The Taoiseach supported Roscommon too.

No other projects have been delayed, omitted or withheld from the capital programme to accommodate these projects. Let us have a discussion about Roscommon some day if Deputies wish. I will tell the House about the increased activities that have taken place at that hospital.

(Interruptions).

The changes delivered have made Roscommon County Hospital a much busier place than it has been for very many years. What we need is to get on with these projects to provide facilities not only in Wexford and Kilkenny but in many other locations around the country.

I welcome the Taoiseach back from his sojourn in Europe. I am delighted to take this first opportunity to question him across the floor of the House. I was very interested in his last replies to Deputy Gerry Adams, because I happen to represent one of those places - that is, Tipperary South, which includes part of west Waterford. We have suffered as a result of this cronyism. Fine Gael and its colleagues in the Labour Party promised us a new beginning and an era of greater transparency, honesty and integrity. It must have all washed down the Liffey in the recent floods, because what we are seeing now is the worst type of political cronyism. The HSE boss at the time, Cathal Magee, and Brian Gilroy, with whom I have an excellent relationship, knew nothing about this. Clinicians and other hospital practitioners in the south east region knew nothing either.

We were all buying into the idea, as we were told by the last Government and the HSE, that the way forward was through the development of centres of excellence, one of which would be located at Waterford Regional Hospital.

All the consultants and everybody down to the porters bought into this and were working towards that. We let services go, as did Kilkenny, Wexford and Clonmel in the case of South Tipperary General Hospital, so that we would have the centre of excellence in Waterford. We heard rumours before Christmas that there was a change of plan and that Kilkenny might align itself with Dublin. We received assurances from the Minister that this was not true. Thanks to our good journalists who made the enquiries under FOI, we found out that political cronyism was flying at its best. We never saw anything like it before. The Ministers for the Environment, Community and Local Government and Public Expenditure and Reform had contacted the Minister for Health and were pulling at the hems all the time. Will the Taoiseach give us a guarantee that he will stop and out this? I know the two of them came to the Taoiseach's rescue and saved his bacon two years ago but this is not fair to the people of the south east or any other region who want patient care and not political slush funds in which the Government is involved in respect of the HSE and its funding with an eye to the next election because it knows its policies have failed in so many other areas, as was referred to recently in respect of the EU.

The Deputy is over time.

We cannot have this. Can the Taoiseach give us an guarantee that the people served by South Tipperary General Hospital and people in the Waterford region will have the services to which they are entitled and that it will not simply be through the efforts of a Minister that a person is treated in a hospital? This is outrageous. The deeds of past Ministers condemned by the Government when it was in opposition pale into insignificance in comparison with it. Those in government are fast learners.

That would be a good speech from the back of a trailer outside Clonmel. I am glad to see the foremost member of the investigative troika in full flight. Compliments to him on his tie. My visit to Davos was not a sojourn, rather, it was a working visit that involved meeting international business leaders and politicians. The dividends will speak for themselves in due course. The Deputy mentioned cronyism and NewERA, for which legislation is on its way.

(Interruptions).

In respect of the difference of opinion between the Deputy and me regarding the meaning of NewERA, in June 2012, the Minister for Health appointed Professor John Higgins to chair a strategic group on the establishment of hospital groups. That board has representatives with both national and international experience in health service delivery, governance and linkages with academic institutions, which are part of progress for the future. The establishment of these trusts is a complex matter and there is an obvious need for communication and direct dialogue with all the organisations and individuals involved. Over 70 meetings have taken place as part of the process of establishing initial hospital groups. I expect the Minister for Health to be in a position to decide on an administrative basis the setting up of these groups inside the next month pending the introduction of the legislation. Before the trusts are legally established, the functioning of the groups must be reviewed and if changes prove necessary, they will be made with Government approval. Clearly, there are different views in the south east. It is an issue of concern from both the political and medical perspectives and relationships between various institutions and personnel all come into these discussions. I expect the Minister to be in a position to finalise that and the other groups around the country in the next four weeks.

I am disappointed with the Taoiseach's reply. How many front-line service staff does Professor Higgins's group include? The answer is none. The people in the south east are working towards the reconfiguration and the centre of excellence in Waterford Regional Hospital in Ardkeen. This has been the template for the past number of years. Will the Taoiseach allow the Minister for Health to wreck that, put people's lives in danger and put the constituents of different Ministers first? We have seen it recently with the distribution of national lottery funds in Wexford. Is this Government aware of the medical and economic consequences of the proposed realignment of hospital services?

Professor Higgins believes his loyalty is to Cork. He also sees a spin off from South Tipperary General Hospital to Cork if Waterford is gone.

That is not true.

The people of the south east will not take this. The Taoiseach should not insult the staff and services in St. Luke's Hospital and in Wexford by saying-----

On a point of order.

(Interruptions).

There will be no points of order. This is Leaders' Questions. I ask Deputy Buttimer to resume his seat.

Deputy Mattie McGrath has named an individual who is not in the House to defend himself and who is acting for a Government of all hues. I ask the Deputy to withdraw the remark.

This is Leaders' Questions. I ask Deputy Buttimer to resume his seat.

I ask the Deputy to withdraw his remark.

I ask Deputy Buttimer to resume his seat. We will deal with this. I ask Deputy Mattie McGrath to conclude. This is Leaders' Questions.

Deputy Buttimer is outrageous.

I ask Deputy Mattie McGrath to conclude as his time is up.

I remind Deputy Buttimer that it was the Taoiseach who first named Professor Higgins.

Deputy Mattie McGrath should withdraw the remark.

Deputy Buttimer is not in the health committee waving his hammer.

(Interruptions).

I ask Deputy Buttimer to resume his seat.

He is not in the health committee to dictate for three days and lay down the law. He is in the Dáil Chamber now. It was the Taoiseach who first named Professor Higgins and not me.

Deputy McGrath is over time.

I accept that. It is a pity he is insulting the work of the wonderful medical staff in Kilkenny and Wexford by saying they were operating in Portakabins and rented huts. The Taoiseach knows better than I do that this is not true and is an insult to the staff.

On a point of order, the Leas-Cheann Comhairle must reprimand Deputy Buttimer. That was an outrageous intervention.

(Interruptions).

I ask the Deputy to resume his seat. This is Leaders' Questions and there will be no points of order. I call on the Taoiseach.

Deputy Martin will have to defend "Fianna Fáil Lite" behind him.

The rationale behind the restructuring of the health system is to establish hospital groups to allow for increased operational autonomy within those groups and to have accountability for hospital services that will drive the service reforms and give the best possible outcome for patients. This is all part of the process of leading to a system where money follows the patient and where we introduce universal health insurance at the end of the process. I deplore Deputy McGrath's comment about Professor John Higgins. I do not intend in any way to offer any insult to the hardworking staff in the south east. They do their job on the front line, as one would expect them to do. The process has involved over 70 meetings. It is never easy to get agreement and consent between any institutions much less in the health area but I hope the Minister will be in a position to conclude on the groupings for the south east. I am not getting into speculation, allegations or rumours about what that might entail.

In respect of Deputy McGrath's comment about the national lottery, each county was given a proportionate amount which is open, transparent and very clear unlike the situation that applied when the Opposition was over here where secret arrangements were made with the Government that were not subject to FOI and where nobody could find out the price of the Government's support every Wednesday when it was needed. The next time the Opposition is back on troika duty, it should make its questions a little more succinct.