When the people spoke last Friday, they rejected the Taoiseach's proposal to abolish Seanad Éireann. In his own words, they gave him one hell of a wallop. I put it to the Taoiseach that he refused to listen to reasoned opinion advocating reform before the referendum. He refused to refer the issue to the Constitutional Convention. He refused to give the people a choice between abolition and reform. He even refused to debate the issue - to take it to the people. Essentially, it was his way or no way. I suggest that the result of the referendum reflects a reaction to the proposal itself and to the Government's way of doing business. We need to be clear that the people voted for a reformed Seanad. They did not vote for the retention of the status quo. There is a legislative template on the Order Paper. I refer to the Bill placed on the Order Paper by Deputy Ross, which is-----
Leaders' Questions
That Bill is also in my name.
-----very similar to the Bill proposed by Senators Zappone and Quinn and the Bill proposed by Senator Crown. All Members of this House have an obligation to put our differences to one side by working to make legislative progress and to achieve the maximum agreement on this matter. Reform can be brought about by legislative means. We need to show a response to the people and to the campaign in which we have just been involved. That would be the correct response right now to the people's decision. Will the Taoiseach have a change of heart? Will he agree to join talks between all the parties with a view to reaching agreement on this legislation to ensure its passage through both Houses of the Oireachtas?
The Taoiseach should have forgotten the book launch.
First, I would like to inform Deputy Martin that I said this was a wallop - not one hell of a wallop.
Can the Taoiseach explain the difference?
He should get his words right.
It was a big enough wallop.
Second, I have already answered the-----
I suppose there was only a couple of percentage points in it.
Deputy Martin can smile away if he wishes, but the position here is that we now need to take a serious view of the decision of the people.
The Taoiseach should take it seriously so.
As Deputies will be aware, the Constitutional Convention was set up with great results to make recommendations to the Government on whether referendums should be held. The Government had decided to hold a referendum on this matter. It is one of the few cases where anybody can say a commitment was honoured. The people have made a clear decision that Seanad Éireann should be retained in our Constitution and that has been accepted by me as Taoiseach.
Does the Taoiseach have any choice?
The people had a choice between voting "Yes" and voting "No". The choices in between had been messed around for 70 years and nobody did anything about them. The issue raised by the Deputy in respect of debates is immaterial. It is important to set out that I was not going to be led by Deputy Martin's agenda or by anybody else's agenda. I made it clear on Saturday in my response to the people's decision, as announced in the result of the referendum, that we need to look at the question of the best thing to do with the Seanad. I have looked at the reports that exist over many years.
Some proposals would not require legislative change, some movement could be made with legislative change, while others would require further referenda. I do not favour the setting up of another separate Legislature by Seanad Éireann. I have said - I am glad Deputy Martin agrees - we should call in the leaders of the parties in the Seanad and engage in a meaningful discussion about what is best to do given the extent of the proposals there are and the clarity of the result of the people and move on. I also make it clear that those discussions are only part of the process of political change that we are involved in as part of wider politics and the management of our affairs in here, which remains, under Article 28(4) of the Constitution, holding the Government to account.
I have a busy schedule, but I will engage with the leaders in the Houses as early as I can. We will sit down and talk about the decision people made that Seanad Éireann continues as part of our Constitution and consider what is the best thing we can do to make it effective and whether we should introduce legislation on the third level sector, which was approved by constitutional referendum almost 30 years ago and never acted on, or whether there are other issues that we should deal with. I will take everyone's view into account. A clear decision has been made and I accept it. I do not think that there is anything wrong with somebody in politics consulting the people when they said they would and accepting their answer. I am up for engaging with the leaders in the Dáil and the Seanad and we will see what is the best way of putting in place a process that will lead to a more effective Seanad Éireann.
The Taoiseach did not consult; he just tried to ram something through without any meaningful consultation and put forward an ill-informed proposal with no proper accompanying constitutional reform. The Taoiseach did not answer the question I put to him. Deputy Shane Ross's Bill is on the Order Paper. Is the Taoiseach prepared to join other parties in discussing that Bill and that legislative template with a view to reaching agreement to have it passed through the House? The Taoiseach has not consulted us on Dáil reform in a meaningful way or in any shape or form. A meeting was convened on Dáil reform two or three days before last Friday's polling day to do what he said he would do some months ago, which is to present us with a fait accompli that he intends to ram through the House this week. There has been no meaningful engagement. That is the problem when he says he will meet leaders - the meeting is about nothing. His proposals on Dáil reform are to sit more and do less.
That is more than Deputy Martin ever did.
The old Fianna Fáil is back - oppose, oppose, oppose.
The people are saying loud and clear that they do not want any more tinkering around with the system or on reform. What they want is meaningful reform that enhances the independence of Parliament vis-à-vis the Government. The Taoiseach is correct that the people have said "No" to his proposal to abolish the Seanad. There is an immediate legislative template on the Order Paper, and it is within our capacity to reach agreement on that legislation with a view to its implementation in the short term.
Like Deputy Martin's reports.
If people want to consider other things after that, that is a matter for the political parties, but we have something definitive on the Order Paper. The people have rejected the Taoiseach's proposal-----
You do not have one.
-----and I suggest to him that, by the way he is approaching things, he is still not getting it. He does not engage meaningfully on a level and fair-minded basis in terms of really listening to other proposals with a view to taking them on board. He just does not do that, and he has not done that in the two and a half years since he came into Government. That is why he was walloped. I take his correction on the kind of wallop it was, but it was a wallop none the less and a wallop as much about how he does things as the proposal itself.
Such a spoofer.
I do not know what meaningful discussions Deputy Martin had when he put forward the abolition of Seanad Éireann into his programme. He certainly did not discuss it with any other party. He then changed his mind when he saw the wind was blowing the way it might suit him.
That is what the Taoiseach did.
It is a bit like what Deputy Martin did back in 2000. Does he remember that?
The Taoiseach is taking us back to 2000. It is 2013. He needs to answer the question he was asked, for God's sake.
That is when Deputy Martin said that he would deal with the working time directive for junior doctors. Let me remind what Deputy Martin did back in 2000 when he consulted the people. He said he would end the working time directive for junior doctors inside nine years.
I did not say that.
They are outside the door.
He then spent €254,000 on a report he never acted on and about which he did not consult anybody. Deputy Ross was an esteemed member of the Upper House and caused great excitement on a number of occasions with valid and colourful contributions. His is one Bill. Senators Zappone and Crown have different Bills and Senator Quinn has other views. Deputy Martin wants to proceed with Deputy Ross's Bill and to ignore the people in the Seanad who are elected by 1% of the people here.
All I heard from Deputy Martin's spokesperson was that savings could be made in the Houses of the Oireachtas Commission. I heard copycat calls as a result of the Zappone Bill. That Bill was passed unanimously on Second Stage in the Seanad. It will commit Senators to halving their salaries, which is an interesting concept.
I will not take Deputy Martin's triumphalist barrage. It is about time people committed themselves to doing what they said they would do. We committed to putting the question and we have an answer. I want to engage in meaningful and comprehensive discussions with the leaders of the parties here and the leaders of the Seanad.
Let us press ahead with it.
That will include discussions on Deputy Ross's Bill, Senator Zappone's Bill, Senator Crown's Bill and the contribution of the former Senator O'Rourke - she is from Deputy Martin's party in case he does not remember - who wants 100 Senators. As I announced on Saturday and yesterday, I will initiate meaningful, comprehensive, thorough and fulsome discussions with everybody as soon as I can, although I have a busy schedule.
I will be waiting.
Deputy Martin's party has had 14 years.
I hope that Deputy Martin or his spokespeople come up with meaningful proposals-----
We have given them to the Government.
-----and not daft ones such as those I have heard in the past.
Still chirpy.
Inniu, tá na dochtúirí sóisearacha imithe ar stailc agus mar gheall ar seo, tá cinntí i dtaobh na mílte daoine curtha ar ceal.
The Government is in breach of the EU's working time directive. It is not alone in this. Deputy Martin was in breach of this EU law when he was Minister with responsibility for health, as was Mary Harney and as is the current Minister for Health, Deputy Reilly.
The Deputy has been in breach of a few laws himself.
The directive stipulates that junior doctors must not work more than 48 hours a week on average. It also requires them to have a minimum of 11 hours rest between shifts. Instead, some of them work as many as 90 hours a week. That is not just bad for doctors because, today, 12,000 outpatient appointments and 3,000 operations have been cancelled.
The working time directive is not a new EU directive; it has been in place since 2000. In 2009, the EU criticised the Fianna Fáil-led Government, and in 2011, it criticised the current Government. Deputy Martin, as Minister with responsibility for health, did nothing.
Not true.
Mary Harney, as Minister with responsibility for health, did nothing, and the current Minister for Health is doing nothing.
Deputy Martin set up three committees, or was it six committees?
I am sure the Taoiseach will agree that no doctor wants to put the well-being of patients at risk, but the failure of the Government to address this issue is putting patient safety at risk. Will the Taoiseach commit to implementing the working time directive fully to ensure junior doctors work safe hours? If so, when does he intend to do this?
I notice that Sinn Féin published its budget proposals earlier. Those included a third higher income tax rate of 48% giving a top tax rate of 59%, including the universal social charge. That means there probably would not be a higher earning doctor left in the country or anybody else when meaningful discussions are held about what that proposal actually means.
Do not worry. Take the time to study it.
This is the report that the party leader to the left of Deputy Adams produced in 2001. It was the report of the national joint steering group on the working hours of non-consultant hospital doctors which cost €254,000 and about which nothing was done.
He is not the Taoiseach.
It has gone on for 14 years without this matter being attended to. It is a fact that Ireland is committed along with the European Commission to the achievement of compliance by the end of 2014. Targets for implementation here were not met by previous Ministers, including Deputy Martin. The Minister for Health is determined to end this and to have it implemented in full by the end of next year, ending 14 years of inactivity.
Yesterday, I met a number of patients whose operations and treatments were cancelled today. There is much anger out there about this. It is very regrettable and will clearly result in a reduction in planned patient treatments. I understand that cancellations will arise in about 7,000 outpatient appointments, 500 day case and 200 inpatient cases. What is all this about? It is about the range of sanctions people want imposed on hospitals.
I understand there is great range of disagreement about what is involved here. Proposals have been tabled in this regard by both the HSE and the IMO. As with any industrial relations dispute, negotiations between the two sides are always the way to achieve a proper resolution. I call on the IMO to re-engage with the LRC process, which is the way to do this, and to desist from any further disruption to services, which is a cause of great distress to patients today.
It is absolutely desirable that doctors enjoy reasonable and proper working conditions. I assure the IMO and junior doctors in hospital that this Government, unlike previous Governments, remains fully committed to and has made serious progress in achieving compliance with the working time directive. In the first half of 2013, 35% of all NCHDs were compliant with the 48-hour week, particularly in specialist areas. I am informed that virtually all non-consultant hospital doctors in radiology, pathology, emergency medicine and psychiatry are fully compliant. The specialities in which compliance has still to be achieved are generally obstetrics, paediatrics, anaesthesiology, surgery and medicine. Average weekly working hours for all NCHDs were 52.4 hours as of July 2013. The Minister and the HSE are now focused on reducing this figure to 48 hours in compliance with the directive. We hope to have that achieved fully by the end of 2014. As the Deputy can see, significant progress has been made here.
Before I sit down, I again appeal to the IMO. The way to resolve this is through the Labour Relations Commission. There are two sets of issues tabled here and that is where the process should end. I appeal to the doctors to go back to the LRC and sort this out in the interests of acquiring proper working conditions but even more in the interests of their patients today, tomorrow and every other day.
I am delighted that the Taoiseach has our budget proposals. I would like him to study them. Feel free to plagiarise them. They are proof that there is a fair way to adjust the deficit.
You might study them yourselves.
If the Government can do it with fairness, it can do it by taking the burden off lower and middle-income families. The crux of the strike involving the junior doctors is the issue of patient safety. It is at the core. What the IMO is saying is that there are no sanctions for those hospitals that are not complying. That is what the IMO wants. The Taoiseach is appealing to the IMO to go forward to the Labour Relations Commission and that is fair enough but would he not ask the Minister to intervene directly to ensure juniors doctors work safe hours and patients get the treatment they deserve? It is fair comment to say that Deputy Martin was in breach of the directive but the Government and the Minister are in breach of this directive.
The Government, and the Minister in particular, have a track record of breaking Government commitments. The Minister promised to abolish prescription charges for medical card holders when in opposition. In office, he increased them. He failed to deliver the programme for Government commitment to free GP care for people with long-term illnesses. He has failed thus far to reduce hospital waiting lists. Like Mary Harney and Deputy Martin, he is great at promises but appalling at delivery. Will the Taoiseach instruct or ask the Minister to intervene directly in this junior doctors' strike?
I have already made the point to Deputy Adams that the Minister's track record since he became Minister for Health has been such that he has reduced the working hours for NCHDs on average to 52.4 hours per week in July 2013.
I will give Deputy Martin the report again.
Deputy Adams asked a question and he is entitled to a reply.
Previous studies have shown that in 2009, average hours worked for all NCHDs were 60 hours per week. It is now down to 52.4. HSE data from 2012 indicated that on average, NCHDs worked 54 hours per week and data for the first six months of this year show an average of 52.4 hours per week. I understand that the number of NCHDs working shifts in excess of 24 hours decreased from 58% in March 2013 to 34% in August. That is progress but we must implement the directive in full by the end of next year.
The establishment of the hospital groups will also empower hospitals to co-operate and share NCHDs when scarcities arise and that will further reduce NCHD hours. In addition, the Minister set up a group chaired by the president of DCU to carry out a strategic review of the medical training and career structures of NCHDs with a view to retention of the number of graduates in the public health system. An interim report on that will be produced in November 2013.
I mentioned the scale of reductions in terms of patient services because of this. It is already Government policy that those waiting longest should be prioritised and the IMO has confirmed, as the Deputy is aware, that same level of staffing as is normally provided on Sundays will be in place. Following discussions at the LRC over recent weeks, a joint IMO-HSE verification and implementation process has been proposed. This has already begun and will continue through October. Actions to change rosters and revise work practices identified during that process will be implemented in November. Implementation and achievement of a maximum 24-hour shift would then be jointly verified by the HSE and the IMO.
After 14 years of doing nothing, the Minister has brought this to a point where, on average, working hours are 52.4 and where we hope that by the end of next year, the working time directive will be implemented in all hospitals. As I pointed out to Deputy Adams, some specialist areas are already fully compliant and discussions are ongoing about the others. Let me repeat that Sinn Féin's proposal to have a top rate of 59% with the USC will drive every worker, business and entrepreneur out of the country.
You are already driving them out.
Sinn Féin actually mentioned that the current VAT rate in the hospitality sector should be retained but it never bothered to say who was going to pay for it.
Twenty years ago, a doctor told me that if I had to go into hospital, I should make sure I asked for a second opinion.
Twenty years ago, he said the doctor might have been on his or her feet for up to two days. This morning on my way to the Dáil I stopped by St. Vincent's hospital to speak to some of the non-consultant doctors who are currently on strike. They told much the same story as I was told 20 years ago. We all know they do not want more money. They told me that if their proposal to shorten their working week is accepted, their overall pay will fall. When I asked them what kind of duties they might perform after spending 36 hours working flat out in a hospital, they said they may have to perform a lumbar puncture or resuscitate patients in the emergency department. They told me about colleagues who had fallen asleep in operating theatres. I do not know if the Taoiseach ever worked 36 hours in a row, although I imagine he has. Having worked that long myself, I know I am not fit to change a light bulb after 36 hours. Several months ago there was consternation when we sat in the Dáil until 5 a.m. Somebody pointed out that at 5 a.m., when everybody was blind with tiredness, we were only halfway through the shift of a non-consultant hospital doctor. Two of the doctors' colleagues tragically committed suicide in the last year. More than half of our newly qualified non-consultant hospital doctors are leaving the country. Those who remained have finally mobilised, for which I say "fair play".
The crisis was not created by this Government but it presents it with an opportunity to get this right. Does the Taoiseach accept the need not only to limit the working shift to a maximum of 24 hours but also to impose binding sanctions on the HSE? The doctors believe there is a lack of credibility, accountability and trust on the part of the HSE. There has been a breakdown in trust and, therefore, they want binding sanctions. Will the Taoiseach stand over a guarantee to the non-consultant hospital doctors to the effect that binding sanctions which the HSE cannot ignore will be introduced as part of the package?
First, the strike should end. This is why I say to Deputy Donnelly, as someone who spoke to doctors this morning, that it is critical the Labour Relations Commission is able to engage with the HSE and the non-consultant hospital doctors, NCHDs. That is where it will be addressed and the only people who really suffer as a consequence of it not being addressed there are patients and outpatients waiting for treatment.
I agree that the situation 20 years ago was as the Deputy described. Over the last 14 years there was no real movement on the issue because of a failure to put in place a process to address it. In fairness to the Minister for Health, Deputy Reilly, who is also dealing with all the other problems and challenges in the health services, he has brought the issue to the point at which significant progress is being made.
Perhaps while Deputy Donnelly is on his way home he might ask the doctors why NCHDs in radiology, pathology, emergency medicine and psychiatry are fully compliant but those working in obstetrics, pediatrics, anaesthesia and surgery are not. Why is it that some specialties are fully compliant in hospitals all over the country whereas others to not appear to be compliant?
Is the Taoiseach blaming the doctors?
Is that a case of managers not being able to manage or is it because of staff shortages?
Ask the Minister for Health.
Deputy Donnelly made a valid point. The way to address this is to take the propositions by the doctors and the HSE back to the Labour Relations Commission. There are two propositions on sanctions on the table and if there is a difference of opinion, surely they can arrive at a workable compromise that will see the directive fully implemented by the end of next year and will not distress patients further. Yesterday I met two patients who had been fasting all day while waiting for treatment today only to find that their treatments were called off. It is distressing for people. The answer lies in the tried and trusted negotiation process of the Labour Relations Commission.
The Government is supposed to be in charge.
Two propositions are on the table. They should go back to the commission to sort out the issue.
That has not worked for them.
Everybody here is interested in seeing that the directive is fully implemented. The Minister set a target for the end of next year and he has made significant progress in that regard, despite 14 years of inactivity.
I thank the Taoiseach for his answer. He asked why there is no consistency and why some parts of the HSE are compliant. It may be due to medical procedural reasons of which I am not aware but it is an interesting question because it brings to the attention of Dáil Éireann the fact that while today's strike is nominally about whether sanctions should be applied - personally I think they should - it is also symptomatic of a malaise in the HSE. The HSE appears to be an organisation with little transparency and huge inconsistencies in how medical professionals and patients are treated. We all know it is not subject to meaningful parliamentary oversight and it is immune from parliamentary questions. There is a significant cultural issue which the Government could begin to address. However, this will require root and branch reform which opens up professional bureaucrats, some of whom are excellent and others are not so excellent, makes what they do transparent and, critically, makes them ultimately accountable to this House. Does the Taoiseach agree that we have a major issue and, ideally, an opportunity in regard to increasing transparency and accountability in the HSE?
On today's strike, does the Taoiseach agree with the thrust of the demand for binding sanctions? Essentially the doctors are agreeing to negotiate but they no longer trust the HSE. If the deal on the table is a promise by the HSE that it will not make them work longer than 24 hours, does he accept it is reasonable that the doctors no longer accept that promise and, therefore, will he support their call for some form of binding sanction? Perhaps it will not be the specific sanction they seek but there should be some form of binding sanction on the hospitals and the HSE.
In respect of transparency in the HSE, no more than any other organisation, agency or Department that is clearly a given. This is why the Minister for Health wants to transfer responsibility for the Vote back to the Department of Health so that it is answerable to this House. Deputy Donnelly will be aware that when an Estimate is concluded in respect of the budget and when the Minister for Health signs off on it with the Minister for Public Expenditure and Reform, it is then necessary for the HSE and the Department to produce a plan or strategy to deal with it. In some cases in the past, these have not corresponded with the Estimate that was actually produced. It is a given that there will be proper transparency.
In respect of sanctions, they are never going to work unless there is a measure of agreement between doctors and managers in a hospital. I do not have the details on all the reasons why some hospitals are compliant and others are not but I understand there are two propositions on the table, from the HSE and the doctors, respectively, on sanctions. That is the point of difference. There is the question of whether they are binding in the way the doctors are speaking about or, to take another form of sanction, a manager's job is to manage and doctors perform a critical public service for the good and health of our people. The place to address this is at the Labour Relations Commission rather than across the airwaves. It is a tried and tested forum and I would say to the NCHDs and the HSE this matter has to be resolved. It can and will be resolved through the forum of the Labour Relations Commission. The invitation has been made to both sides. The propositions are on the table and surely it is possible to work out a solution rather than leave people distressed and put out because of the situation that obtains at present.
I do hope that, following the Deputy's valid question, this will be responded to in a positive fashion and it is to be hoped it can be resolved, understanding that we want to get to a point at the end of next year where the working time directive is fully implemented in respect of all the doctors and all the hospitals, as it should have been many years ago.