Dáil Éireann debate -
Tuesday, 4 Mar 2014

Vol. 833 No. 1

Leaders' Questions

Deputy Micheál Martin

This week the Executive has usurped the Parliament and has forced upon us for the next three days a debate on Government priorities, with no legislation at all tabled by the Government side. In that context, could the Taoiseach confirm whether the Government has delayed making any decision on implementing the plans of the Minister for Health, Deputy Reilly, for universal health insurance for a year until a major costing exercise is complete? A draft memo that the Minister for Health circulated to his Cabinet colleagues found its way into The Irish Times this morning and many caveats have been put in regarding the timetabling and the plan itself. It might be a good exercise in the public interest to publish that draft memo so we could all see it and have a reasonable chance this week, when we discuss the Government's priorities, of discussing its major priority - namely, the introduction of universal health insurance, allegedly, in approximately six years' time. It would be no harm if we could have the opportunity to discuss that meaningfully this week, given that we are meant to be discussing Government priorities.

People would like to know the potential cost to them, as individuals and families, of such a new system. The Dutch model has increased overall per-capita costs by approximately 46% since its introduction in 2005. We need a very honest debate with people. Somebody somewhere has to pay for health services. Somebody will have to pay for the future health service irrespective of the funding model adopted. Would the Taoiseach accept that there will be a significant increase in costs to the Exchequer in the years to come following the introduction of the universal health insurance system? There will also be a significant cost to individuals and families. The 2 million people who already have health insurance will face extra costs for the basket of services they enjoy under the health insurance policies they have.

Also, approximately 1 million people have neither medical cards nor health insurance. The Taoiseach needs to be honest and tell the people concerned that they will pay a tax from now on in the context of the new model. We need to be straight with people in that regard.

Has the Taoiseach deferred making a decision on the Minister for Health's plans until a full costing exercise has been completed? Does he accept that there will be an increase in overall health expenditure for the Exchequer as a result of the introduction of universal health insurance, about which the Minister for Finance, Deputy Michael Noonan, and the Minister for Public Expenditure and Reform, Deputy Brendan Howlin, have articulated concerns? Does he accept that there will be an increase in costs for many individuals who currently have health insurance? The Minister, Deputy Brendan Howlin, has said the cost of health insurance could be up to €1,600 per person per year.

The Taoiseach

No, I do not accept that at all. First, the Government has not put off a decision on universal health insurance, UHI, until next year. I do not accept the Deputy's premise about an increase in costs for each individual. I accept that this is the most radical and fundamental change in the health service structure since the foundation of the State. We cannot continue with a system that is inequitable, unfair, which penalises those on lower incomes and costs an extraordinary amount of money. When the Deputy was Minister, it cost €16 billion.

The Government's decision today was to confirm the concept and principle of universal health insurance. However, there is clearly a need for a process of consultation with the people in order that everybody will understand what is involved. The fundamental difference between what is in place and what will apply under universal health insurance is that the package of services that will be available and the choice for each person as to what is most suitable for him or her will include access to primary care and GP care. Therefore, the cost being paid for that currently will not be a cost under UHI.

It is a matter of considerable importance that there be no confusion. Therefore, the process of consultation will involve ordinary citizens, men and women, around the country who will be impacted on by this change and the Oireachtas Joint Committee on Health and Children which will have a central role to play and provide an understanding of or an explanation for the value of having a single tier system that will provide equal access, rather than having a two-tier system which is discriminatory, unfair, exceptionally costly and does not work.

I think what the Deputy is trying to get at is whether I can tell him what the average cost will be per package. I cannot do that because UHI will not be implemented in full for some time, but the process is in train. We have the strengthening of primary care services, the special delivery unit, the establishment of six hospital groups, the patient safety agency and the first phase of the money follows the patient approach. These are all parts of the process leading to implementation of universal health insurance.

To answer the Deputy's question, the Government has accepted and confirmed the UHI concept and principle. It is continuing to discuss the question of how best to roll it out and the process through which we can explain exactly what is involved. I do not accept the Deputy's figures or his assertion that this will cost more. The Minister for Health has said-----

Deputy Michael Healy-Rae

He is always right.

The Taoiseach

He has already said universal health insurance cannot cost more than the ineffective two-tier system and that implementation of the programme will be subject to the constraints and ceilings set by the Minister for Finance and the Minister for Expenditure and Reform.

Deputy Micheál Martin

The Taoiseach has confirmed what I said in my original question; the Government is delaying universal health insurance, UHI. He has just said the Government confirmed the concept, but the concept was confirmed before the last general election, with statements like the "money follows the patient" and that kind of soundbite which got him through the last general election.

The Taoiseach has now teed it up to get himself over the next election with no detail. He will certainly get by the local elections with absolutely no detail. The only ones sowing confusion are the Taoiseach and the Minister for Health, Deputy Reilly. The plan now is to get to the next general election, when the Taoiseach will tee it up again and make the exact same promise he made three years ago, which will then be five years ago, and say we have another five years to go before we implement this, with no detail whatsoever.

Deputy Jerry Buttimer

That is called commissioning reports.

Deputy Patrick O'Donovan

Deputy Martin will go into the local elections himself.

Deputy Micheál Martin

The Taoiseach needs to be honest with people and say this will cost more. It will cost people extra money. I was not the first to say that. The Ministers for Finance and for Public Expenditure and Reform, Deputies Noonan and Howlin, were the first to raise the red flag on this.

Minister for Finance (Deputy Michael Noonan)

I never said that.

A Deputy

The Deputy published so much when he was on this side of the House.

A Deputy

Bring in a consultant.

Deputy Micheál Martin

The Minister is shaking his head. He should publish the memo that was circulated today. Why not publish it? If The Irish Times can get it, surely the Dáil can get the memo. Why not publish the White Paper?

Deputy Finian McGrath

The Minister for Finance needs to get his sums right.

Deputy Micheál Martin

The people have been waiting three years for the White Paper on universal health insurance.

Deputy Bernard J. Durkan

We waited 15 years for things the Deputy never did.

Deputy Micheál Martin

Despite all the talk of radical change, the only reality for people is that the cost of health insurance policies has gone up 60% in the meantime. Tax relief for health insurance policies has been curtailed.

Deputy Jim Daly

Whose fault is that?

Deputy Micheál Martin

There is serious uncertainty about the private health insurance market.

Deputy Kevin Humphreys

So says the boy who bankrupted the country.

Deputy Micheál Martin

That is what is happening now. The same is happening with medical cards. They are being taken from people.

Deputy Bernard J. Durkan

The Deputy ran from the Department of Health.

Deputy Emmet Stagg

His government built the HSE. It was the architect of the disaster.

Deputy Micheál Martin

Thirty-five thousand medical cards are being taken from older people this year. Disgracefully, medical cards have been taken from young children with multiple special needs. People are worried because their sense of universal health care as advanced by this Government has meant a withdrawal of services-----

Deputy Bernard J. Durkan

Will the Deputy apologise to the people for what he did to the country?

Deputy Micheál Martin

-----in the primary care field, the acute hospital setting-----

Deputy Patrick O'Donovan

Will Deputy Martin apologise at his party’s Ard-Fheis for what it did to the country?

Deputy Micheál Martin

-----and in the community care setting through the reduction in home help hours, the massive increase in private health insurance premiums and the reductions in tax relief. There is an incredible yawning gap between the reality as experienced by people and the rhetoric peddled day in, day out, with no detail and no serious or substantive debate in this House about what is supposed to be the Government’s number one priority. It has not even been tabled for debate this week.

Deputy Patrick O'Donovan

They will say Deputy Martin bankrupted the country.

Deputy Bernard J. Durkan

Fifteen years.

The Taoiseach

The Deputy has had his little rant.

Deputy Bernard J. Durkan

The Taoiseach should not encourage Deputy Martin.

The Taoiseach

I do not accept at all his assertion that this is an attempt to put universal health insurance and the explanation of it out beyond the next general election. As I have said on many occasions, that will be in spring 2016. Long before then, people will understand. The universal health insurance concept, principle and proposal-----

Deputy Michael Healy-Rae

And the price.

The Taoiseach

-----will be explained to people so that everybody understands the value of having a single-tier system as against a two-tier system.

Deputy Martin would say that costs will increase. Why would he not? After all, in his own time the cost went up by over 320%-----

Deputy Micheál Martin

It never did.

Deputy Timmy Dooley

The Taoiseach is the one who made the promises.

Deputy Michael Healy-Rae

The Taoiseach will not leave anything.

The Taoiseach

-----from €3.6 billion to over €15 billion, and we ended up with nearly a world record of 569 people on trolleys on one day in January 2011.

Deputy Timmy Dooley

The record is stuck.

The Taoiseach

That is the legacy the Deputy left.

Deputy Micheál Martin

We have a very fine legacy in health.

The Taoiseach

That is a system that he appears to want to defend, continue and perpetuate. It is very necessary, with the rise in population, the longevity of people now-----

Deputy Micheál Martin

Why are people living longer?

The Taoiseach

-----and changes in medical systems, that we move to a single-tier system of health.

Deputy Micheál Martin

Something must be working. Does the Taoiseach have a problem with longevity?

The Taoiseach

This works in most other countries in Europe, and what will apply here will be a system that is very suitable for our needs here in Ireland.

Deputy Timmy Dooley

The Taoiseach’s own lads are laughing at him.

Deputy Sean Fleming

They are laughing at the Taoiseach.

The Taoiseach

The Deputy mentioned private health insurance. The Minister for Health has said on many occasions that the McLoughlin report, for instance, pointed out way after way for private health insurers to reduce costs. The VHI increased its cost by 2% while others went up by 13% or 15%. This will have an impact on everyone in the country. We want to get it absolutely right.

Deputy Michael Healy-Rae

It will be after the elections.

The Taoiseach

It will be central to this radical change to the way health services are delivered. That is why the Joint Committee on Health and Children will play a central part in dealing with the preparation and analysis of the baskets of services to be provided.

Deputy Sean Fleming

Deputy Jerry Buttimer will save us.

The Taoiseach

Everybody will understand that what is involved is equity in access to treatment on the basis of medical need, as distinct from what one can pay and, in terms of community rating, those on lower levels subsidising those on higher levels. This is a serious piece of restructuring of the health service and I accept that we have to get it right. I do not want to see a situation where everybody is floundering around in confusion about what it does not mean and about costs that have been assessed.

Deputy Timmy Dooley

The Taoiseach must be joking.

The Taoiseach

Members of the Deputy's party used to speak about exorbitant charges for this, that and the other.

Deputy Micheál Martin

Will the Taoiseach publish the memo?

The Taoiseach

Yes, we will publish it very soon.

Deputy Timmy Dooley

After the election.

Deputy Michael Healy-Rae

On 24 May.

Deputy Barry Cowen

The June bank holiday weekend.

The Taoiseach

In the next couple of weeks.

Deputy Micheál Martin

The Taoiseach told me that four weeks ago-----

The Taoiseach

I did.

Deputy Micheál Martin

-----and four weeks before that.

Deputy Bernard J. Durkan

The Deputy told the people nothing.

The Taoiseach

I did not tell him there would be an increase of 320% and I do not accept his figures. This is about getting it right because it is going to apply to every person in the country. Everybody will have a say and Deputy Micheál Martin can defend what he wants - an inequitable system that is grossly over cost and not working in the interests of the people.

Deputy Finian McGrath

Deputy Jerry Buttimer will fix it.

Deputy Jerry Buttimer

The Deputy was damn glad to have the Minister, Deputy James Reilly.

Deputy Micheál Martin

That is uncalled for.

An Leas-Cheann Comhairle

Order, please.

Deputy Michael Healy-Rae

That was not a smart thing to say.

Deputy Timmy Dooley

From the man to whom the Taoiseach is giving responsibility to sort the matter out.

Deputy Gerry Adams

As the Taoiseach will be aware, 48 young people were killed in this city in the Stardust fire in 1981. It was one of the greatest tragedies to befall the people of the capital city. The original inquiry into the fire found that the cause was probably arson, but that finding has long been disputed by the families of the victims and others who have examined the evidence closely. The families of a number of those who died in the fire asked various experts to review the transcripts of the original inquiry and these experts have come to an entirely different conclusion. As the Taoiseach will be aware, the families are seeking a new commission of investigation into this terrible event. The main basis for this request is the report by a senior counsel, Mr. Paul Coffey, whom the previous Government tasked with reviewing the Stardust affair and the Foy report commissioned by the families. I hope we can persuade the Minister for Justice and Equality to change his mind, but thus far he has rejected calls for an inquiry into the Stardust tragedy. Will the Taoiseach meet the families of the victims to discuss their demands? Will he support them in their search for justice and establish a new commission of investigation to be headed by a judge and which would draw on whatever expertise was necessary to examine this tragedy?

The Taoiseach

I have had some engagement with Stardust survivors in the past few years and raised the issue on a number of occasions when I was on the other side of the House. In the recent past, anytime I have been in contact with survivors of the Stardust, I have been accused of not telling the truth or it has been said I should produce information or evidence that would alter what has already been determined. I told them that if they had a legal person who had evidence that was new or could confirm what they were saying, it should be produced. However, I receive requests to produce photographs of flooded basements or to show there was no fire in the ceiling space. I do not have that information. Any time I respond on this issue I am accused of telling lies.

Of course the survivors and siblings of those 48 young people who died at the Stardust deserve to have the full facts determined, but this has been examined pretty exhaustively on a number of occasions, and a number of other matters were attended to. I understand there is a question of outstanding legal fees of a pretty serious nature.

The families will have met Deputy Martin, Deputy Adams and others in the recent past, but Deputy Adams is asking me to form another commission of inquiry. I am being asked to determine whether there is some other evidence that will confirm a different version of what has already been determined. All I said to them on the last occasion was that if the legal person they have employed has evidence that is new, different and confirms what they say, then that should be provided to the proper authorities. If that is available - I do not know whether it is - I would respectfully suggest that this is a way forward in the process.

Deputy Gerry Adams

I thank the Taoiseach for his answer. I accept his assertion that he does not have the information that he mentioned - how could he have it? However, I have the two Coffey reports here. It is important to note that the Coffey report was submitted to the Government on 10 December 2008. It is clearly a report with his findings, conclusions and recommendations. I am working my way through this and the families have a solicitor doing the necessary forensic scrutiny of the report. There were changes in the report; in particular, in the report submitted on 10 December 2008, Mr. Paul Coffey SC stated on page 70, paragraph 5.13, "I further accept that a new inquiry is necessary if it is the only way of placing on the public record a finding that is based on [fact]", yet that was left out of the report on its publication in 2009. I appreciate that the Taoiseach might not have an explanation for this omission. If he does not, that is fair enough. However, I would ask him, if he cannot tell the Dáil today why this is the case, that he undertake to do so as soon as possible.

The families have concerns, and I have listened to them, as the Taoiseach stated, as has he. However, even in terms of the original recommendation of the Coffey report that "a new inquiry is necessary", if I understand the Taoiseach's answer, he is stating that if the evidence is given to him he will open up a new commission of investigation, and that he needs the evidence to go to the proper authorities. I am looking for a little clarity on that. The fact that people are so anxious 40 years on is a sign of the trauma they all have been through. I draw that one particular point to the Taoiseach's attention and I would ask him to be open to the request that a new commission of investigation be set up.

The Taoiseach

I know where Deputy Adams is coming from and I accept the genuineness of his question. Any time I have met the relatives of the Stardust victims, it was obvious that their pain was still palpable. We understand that.

If Deputy Adams advises the legal person that the families have employed to send me his evidence of what is different, new and warrants further analysis, I will consider that, but, as Deputy Adams will understand, I cannot commit to a commission of inquiry. This has been looked at exhaustively and extensively on a number of occasions. However, as I said to those who contacted me, if there is new evidence-----

Deputy Finian McGrath

There is.

The Taoiseach

-----and if that is available to the legal person, I invite the families to make a submission to me on that basis and I will consult with the Minister for Justice and Equality on the basis of that evidence, new or different, on how it might progress this matter.

Deputy Joan Collins

I wish to raise with the Taoiseach one of the most immediate and pressing issues that has developed in the past six months, that is, on top of the already critical homelessness problem, the new phenomenon of young families finding themselves homeless owing to a number of factors. A family of two adults and two children who have been in touch with us are living in Bewleys Hotel since November because they could not afford to pay the rent increases demanded by their landlord. They are on the housing waiting list of South Dublin County Council, but they will not get a house for the next seven years. They have been advised by the county council to look outside Dublin for something that is affordable. Calls from constituents are more frequent following the introduction of the rent assessment scheme as people are finding that their landlord is coming back to sell the home. They have been advised to hold on to the leases because they have nowhere else to go in Dublin because of rent increases. In the past three months in the Dublin 8 area alone rents have increased by almost 10%. To rent a house in Drimnagh, Dublin 12, it costs about €1,200 a month.

Last week or the week before young homeless men were found sleeping in bins, one of whom was almost killed. A young homeless lad has contacted us twice in the past three weeks. He was asked to telephone the emergency services at 2 p.m. only to be told the available accommodation was full. He was asked to telephone again at 10 p.m. when again the accommodation was full. He was given a sleeping bag, as he had to sleep on the street. That is what is happening. More families are on the streets than ever before. Focus Ireland has stated the number of families who are becoming homeless each month has increased from eight to 16, while some five children find themselves homeless each week. Is the Taoiseach aware of this trend? Some of his backbenchers from County Kildare have raised the issue in parliamentary questions. What is the Government doing to remedy the problem? The real issue is that in 2008 €1.4 billion was allocated for housing. In 2012, 2013 and 2014 the amount was reduced to €300 million, a decrease of 80% in the allocation for social housing and in expenditure on housing nationally. The dependence of previous Governments on private developers to build social housing and on private landlords to provide social housing is coming home to roost. What is being done about this? There is a need for an immediate response by way of organising an emergency conference to deal with the issue. Given that some 90,000 families need homes, why is this need not being addressed?

The Taoiseach

The point the Deputy has raised has been raised with me and the Government by a number of Deputies from all parties. I was on Merchant's Quay some time ago with Deputy Catherine Byrne where I met some of the homeless community. I understand the pressures they are under. Deputy Joan Collins is well aware that almost 100,000 houses were built in Ireland during the so-called Celtic tiger years at a time when we needed 25,000 to 30,000. Today 7,000 or 8,000 houses are being provided when we need 25,000 to 30,000. What the Deputy has said is true. It is not only those who are single who are on the streets because of one problem or another but families also. There is pressure on families who are not homeless but who are cooped up in apartments and want to move to detached homes. This is part of the discussion the Government is having on the construction sector which is too small and not contributing either to the economy or employment. This needs to be rectified. The issue is how to deal with derelict units that should be renovated for the provision of adequate units for homeless people and families. The Minister of State at the Department of the Environment, Community and Local Government, Deputy Jan O'Sullivan, is dealing with this issue. Recently there was approval for the cross-departmental group dealing with homelessness. As the Deputy is aware, it is a Government priority and part of the programme for Government that the problem of long-term homelessness be eliminated by the end of 2015, which means that there is not much time left. The issue requires a good deal of concentration and it is my intention to call in the agencies, with the Minister, to see what is included in the programme. I recall seeing a picture of a homeless man featured in one of the Irish newspapers before Christmas.

He had been homeless for ten years. Given the extent of the public funding of these agencies, I just do not understand how that can be. We have got to find out the answers to these questions. People are entitled to have a roof over their heads, a home they can call their own and be able to get on with their lives. Some require attention, assistance and support because of a variety of complications, as the Deputy is well aware. Her question is valid but I want her to understand the Minister of State is focusing on this and will report to the Government. She will meet representatives of the homelessness agencies in the near future to determine what precisely the programme is, how we can get to a point where Dublin City Council can assist with vacant, dilapidated and decrepit buildings, what the social housing provision will be and the figures pertaining to families who are homeless and obviously caught in the trap of pressure and demand. Rents are now increasing all over Dublin and this is causing serious pressure for some of the families.

Deputy Joan Collins

We know what the needs are. Some 90,000 families are on the waiting list nationally. In Dublin alone, there are 16,100 families on it. This amounts to approximately 170,000 individuals, which is the population of Wexford and Leitrim combined. This is not a question of having discussions or waiting for a month or three weeks to have a meeting. The problem needs to be addressed now; we know what the needs are. There is a housing crisis. There has been a 60% increase in the number of homeless over the past three years. Moreover, there are those who cannot afford to pay their rent, and the rental accommodation scheme is not an option for them. The local authorities cannot provide housing for them.

Deputy Catherine Murphy said that yesterday the housing officer in Kildare interviewed 16 families and could not take on the extra people who needed to speak to the homelessness agent. One family approached the Deputy after it having split up. They have nowhere to go. The father is currently sleeping on a couch in circumstances in which his life has already been threatened, but he cannot leave. The mother, who has fallen ill, and the nine-year-old boy are staying with a friend. There are so many such cases that an immediate, emergency response is required. We must put ourselves on a war footing. This is not something to be discussed down the line. We need to hear such a response from the Taoiseach today.

There are people experiencing homelessness. I hope none of us present will ever experience it. Many people are only a week away from homelessness. We want to see action on this and an emergency approach. It is not good enough to say discussions have been taking place over a period. Amnesty International has stated this is a human rights issue.

The Taoiseach

It is wonderful for Deputy Collins to point out that there are 90,000 people on the housing list; we know that.

Deputy Timmy Dooley

It is not wonderful.

The Taoiseach

The Deputy wants an immediate response. I am sure she understands that Dublin City Council or any other local authority cannot just move in on a site tomorrow and say a specified number of houses are to be built there. Things do not work like that in reality.

This is a fuse that has been burning for quite a number of years. The Government is left to clean up another mess here. That there are 90,000 people-----

(Interruptions).

The Taoiseach

We recognise that the construction sector-----

Deputy Timmy Dooley

That is a lovely soundbite.

Deputy Micheál Martin

The Labour Party was-----

Deputy Jim Daly

Fianna Fáil has let its developer friends buy out the contract.

The Taoiseach

I thank Deputy Cowen for his comments.

An Leas-Cheann Comhairle

Could we have order for the speaker?

The Taoiseach

The fact is that there are now 90,000 people on the housing list and they need accommodation. Every Deputy present knows well the pressure on families to move out of apartments that are too small to detached homes, particularly in greater urban areas.

Deputy Catherine Murphy

It is not that they are too small.

Deputy Joan Collins

They have been thrown out of their homes.

The Taoiseach

The Deputy started out by talking about homelessness and then she mentioned 90,000 people.

Deputy Joan Collins

On the local authority waiting list.

The Taoiseach

She should not get them confused in that there is pressure on the construction sector and pressure on for housing. We will have the full debate on housing here shortly.

Deputy Timmy Dooley

God help us.

The Taoiseach

I would like to hear Deputy Collins's proposition that will bring about an immediate response. We know from the homelessness agencies about the people who are homeless.

Deputy Finian McGrath

The Government is three years in power.

The Taoiseach

We know the support, including financial support, that is being given to them.

One cannot just put them into prefabricated buildings here, there and everywhere. There is a process to be gone through.

(Interruptions).

The Taoiseach

If the Deputy does not wish to hear the truth, do not listen to it. A process must be gone through to provide proper housing accommodation for people who need it.

Deputy Emmet Stagg

Fianna Fáil caused it when it stopped building ten years ago.

The Taoiseach

That means blocks, concrete, bricks and mortar. It means one must put in place a process to know what must be provided and go through the proper channels to secure planning permission and so forth. We have said quite clearly that the construction sector must step up to the mark. We cannot have any more pyrite and Priory Halls. Of course it is a priority for the people who are homeless.

Deputy Barry Cowen

It is not a priority.

The Taoiseach

God love them, we are anxious to do something for them as quickly as possible. However, the Deputy will not get an answer to her question tomorrow. There is a process to be gone through, including planning, the provision of sites and the provision of finance to build these houses and move people into them. Even the Deputy knows one cannot do that in the space of a couple of months. What one must do is set out the steps and strategy-----

Deputy Barry Cowen

The Government has had three years.

The Taoiseach

Yes, and it has gone on all during the years, Deputy Cowen. The Deputy is not responsible for any of this, but we know what happened-----

Deputy Joan Collins

The Taoiseach is in power now.

The Taoiseach

-----and we are still paying the price. God knows, the people who are homeless on the streets and those who need housing are paying the price of greed and profligacy and money being fired around this country like confetti during the so-called boom years.

Deputy Timmy Dooley

You were demanding much more.

The Taoiseach

We must clean up that mess too, and we will.