Dáil Éireann debate -
Wednesday, 25 Jun 2014

Vol. 845 No. 2

Leaders' Questions

Deputy Micheál Martin

There have been very serious revelations in The Irish Times today on the dysfunctionality and disconnect in the management of our health services. I note in particular the correspondence between the CEO of the HSE and the Secretary General of the Department of Health who, no doubt, was doing the bidding of the Minister for Health. The correspondence was on the HSE CEO's attempts to fill 253 vacant consultant posts nationally. It is now the case that 12% of consultant posts are vacant, which is causing a real crisis in the delivery of services to our people. The CEO was seeking a restoration of what was cut in 2012. The correspondence reveals that the figures produced in the budget to cut health by €600 million were never real. The HSE is at pains to point out in the correspondence that it never signed on for these figures or for Haddington Road notwithstanding that people claimed publicly that it did. It was then expected to deliver on the figures.

We had further revelations in the article in The Irish Times by Professor Donal O'Shea on last week's decision to stop surgery for obesity in St. Vincent's University Hospital and the dysfunctionality the decision involved. The decision will cost lives. These are people who are extremely obese and need the surgery which has been stopped. Professor O'Shea wrote aptly that leadership is absent and chaos reigns. Last week, we had the revelations on the community mental health service where patients are dying in the care of the HSE itself. We had stark revelations on the programme "This Week" on Sunday.

The foregoing reveals without any doubt that morale is extremely low within the health service. There is a complete absence of coherent management within the service and frontline services and the safety of patients are at risk, particularly in the context of the vacancies across the country in so many consultant posts. Does the Taoiseach accept that the figures produced in this year's budget were false and bore no relation to the reality of what could be achieved by the HSE? Does he still have confidence in the capacity of the Minister for Health, Deputy James Reilly, to manage our health services?

The Taoiseach

I do not accept the Deputy's assertions at all. In areas as significant as the Department of Health and the HSE, there will always be opportunities for differences of opinion to arise. I have no idea how letters between the Secretary General of the Department of Health and the CEO of the HSE found their way into to public domain. As Deputy Martin is well aware, things like this usually have a means to find their way into the public domain.

I point out to the Deputy that there were 29,000 fewer patients on trolleys last year compared to 2011. The number of adults waiting eight months or more for day-care surgery is down by 99%. I recall that was going to be ended way back in 2004. Consultants now see and discharge patients on a 24-7 basis, saving the State hundreds of millions of euro, an issue that was not tackled in previous years. The establishment of hospital groups represents the most fundamental reform in the health service in decades. With on average one new primary care centre being opened each month, we are moving to community care facilities which is important.

I saw the article this morning on obesity. I understand that surgery is necessary in a number of these cases. I understand that there was an allocation made for 20 such operations this year and that has been gone through. I do not accept the Deputy's assertion on mental health services. I dealt with this yesterday. The current Government is the first in decades to remove the entire mental health service from being the Cinderella of health services and to make it mainstream. We ring-fenced money for that purpose. I note that the suicides discussed yesterday, tragic though they are in every case, happened in the care of professionals who have been speaking out about these things. The Minister of State, Deputy Kathleen Lynch, has taken a particular interest in this matter and has been consistent in seeing that the best services are made available to the people who require them.

The HSE has pointed out to the Department of Health the establishment of a reference group to provide support to HSE members and the management negotiation team during the LRC engagement in the context of the MacCraith report, which was published. The Department of Health will continue to work to implement the recommendations of the MacCraith report. The current difficulties with recruitment and retention of doctors relate to a wide-ranging and long-standing set of issues. That was the context for the establishment of the strategic review of medical training and career structures chaired by Professor Brian MacCraith. The review group has issued two reports to date and the final one is expected by the end of the month. It is a fact of life that while these things remain unresolved and we await the further report before taking further action, many of the positions are being filled through applications by agencies. That imposes a higher cost on the taxpayer and public service. This is an issue which requires further attention and it will receive it.

The answer to the Deputy's final question on confidence in being able to sort this out is "Yes". The serious progress which has been made on the issues I have mentioned which were left lying around for years without attention speaks for itself.

Deputy Finian McGrath

The Government must deliver.

Deputy Micheál Martin

The Taoiseach might be clearer in expressing confidence in the Minister, Deputy Reilly.

The Taoiseach

Yes - "Y, E, S".

Deputy Micheál Martin

The Taoiseach might read the Mental Health Commission report due today. It states the complete opposite to what the Taoiseach has been saying. The commission is disappointed about the health services. Across mental health hospitals and mental health care facilities, 44% of all posts are vacant.

Some €15 million of the €35 million ring-fenced was taken by the Minister for Health, Deputy James Reilly. The report reads as a damning indictment of what has been ongoing in mental health services. The first question I asked was whether the Taoiseach accepted the figures produced for last year's budget were false. He did not reply. What the director general is saying to the Secretary General of the Department of Health is telling when he says the decision is made elsewhere, without formal consultation with the HSE on the final proposals. We saw this last year and all of the problems emanate from the budget which was back-of-an-envelope stuff in terms of the budget negotiations. It is having telling consequences for patients. The Taoiseach mentioned 20 operations in the case of obesity-----

An Ceann Comhairle

A question please, Deputy.

Deputy Micheál Martin

Between Galway and St. Vincent's hospitals, there were 100 a year, but as a country we should be carrying out 1,000 on people who are extremely obese. The Taoiseach says 20 is good enough.

The Taoiseach

The Deputy is twisting my words.

Deputy Micheál Martin

These are life-saving operations and save time and are efficient. In the context of acute services, they remove many of the expenses attached. The Taoiseach should intervene immediately. Professor O'Shea is correct. That something like this can happen reveals a telling lack of leadership within the health system.

An Ceann Comhairle

Will the Deputy, please, put his question?

Deputy Micheál Martin

Life-saving operations should not be stopped. Does the Taoiseach accept that the figures produced in the budget for this year were false and that this is why we are having issues across the spectrum of management of health services? Will he intervene to get operations to treat obesity back on track at St. Vincent's University Hospital?

The Taoiseach

The Deputy's assertion that there should be 1,000 operations a year to treat obesity is the politics of failure.

Deputy Micheál Martin

It is not my assertion; it is the assertion of Professor O'Shea.

Deputy Willie O'Dea

The Taoiseach is failing because he is not doing it.

The Taoiseach

I am not an expert in the requirement for surgery, unlike Professor O'Shea who is making a point that there is insufficient money available to perform the number of operations he thinks should be carried out. I am not going to quibble with the consultant's professional experience as he is an expert in the field. Deputy Micheál Martin knows that, as a nation, we have a challenge facing us in terms of the health initiatives taken in the management of people's lives, their diet and activity levels. The consultant also points out that it takes up a lot of time.

Deputy Micheál Martin

These are emergency operations.

The Taoiseach

I am not in a position to determine the question of the number of such operations that need to be carried out. The figures produced in the budget were always known to be challenging.

Deputy Timmy Dooley

False.

The Taoiseach

We said this at the very beginning and I have already pointed out that there will be a necessity to have a supplementary budget in 2014. On more than one occasion I have pointed out that the major issues which for years were never tackled are now being tackled and that serious progress has been made.

Deputy Timmy Dooley

The Government has had three years.

Deputy Patrick O'Donovan

Fianna Fáil had 14 years to wreck the country. Is the party looking for an MEP?

Deputy Billy Kelleher

The Deputy broke a promise also.

The Taoiseach

Of course, it is not to everyone's satisfaction and the Department of Health is being tackled as part of the major initiative to get the health service right. Deputy Micheál Martin failed in his responsibility to deal with many of these issues. As we move toward universal health insurance in the next few years, the cost, effects and benefits will be seen by everyone. This is a broad spectrum and the Deputy wants an answer to every question now. These are issues he never went near when he had responsibility for them.

Deputy Gerry Adams

For some time Sinn Féin has been trying to get the Taoiseach, other Ministers, particularly the Minister for Health, Deputy James Reilly, to set out in full the circumstances in which the Minister appointed the founder of and a 50% shareholder in a private health consultancy firm to the position of chairman of the West-North West Hospitals Group. The group then awarded the potentially lucrative public contract for a review and a report on maternity services in that region to the same private consultancy firm in direct breach of guidelines. Despite raising this issue with the Taoiseach and an Teachta Caoimhghín Ó Caoláin raising it directly with the Minister for Health, there has been no full statement on the issue. This flies in the face of the programme for Government commitment that "We will pin down accountability for results at every level of the public service – from Ministers down ... [and] will cut back the waste and political cronyism built up over the last decade". There is no accountability on this issue and it is a scandal that the Government is drip feeding the information instead of coming in and, transparently, doing its duty by telling the Dáil what happened and allowing us to make a judgment on it. My questions concern how the founder of and a 50% shareholder in a private health consultancy firm was appointed as chair of a public body by the Government and awarded a major public contract. Will the Government publish the HSE's review of how the firm was awarded the contract to examine maternity services in the region?

The Taoiseach

As I mentioned to the Deputy yesterday, the second question on the Order Paper is a Priority Question tabled by a competent man, the Sinn Féin spokesman on health, Deputy Caoimhghín Ó Caoláin, and concerns that issue. The question reads "To ask the Minister for Health if he will set out in full the circumstances in which he appointed a founder and 50% shareholder in a private health consultancy firm as chairperson of the West-North West Hospitals Group which subsequently awarded a contract to said firm; if the potential conflict of interest was known to him when he appointed the person and, if not, when he became aware of same; the date on which he became aware of the breach of the financial procedures of his Department in the awarding of the contract; the further steps he has taken since the resignation of the person concerned; if he has considered his own position; and if he will make a statement on the matter". If the spokesperson, Deputy Caoimhghín Ó Caoláin, has issues arising from it, he can follow up on them with the Minister for Health. Perhaps Deputy Gerry Adams might communicate more clearly with him.

Deputy Sandra McLellan

This is Leaders' Questions.

Deputy Gerry Adams

If the matter was not so serious, this would be bizarre. Flann O'Brien could not write it better. I was here when that competent man asked the question and it is interesting that the Taoiseach should read it out in response to mine. The Minister did not answer it in full. If he had answered it, I would not be raising it during Leaders' Questions. What are Leaders' Questions about? They are about the Opposition getting answers about this and other issues of grave importance and accountability mechanisms in the public service.

Deputy Michael Healy-Rae

Ask him again.

Deputy Gerry Adams

The circumstances are clear. A public contact was awarded to a private consultancy firm and the founder and a 50% shareholder in that private firm was appointed as head of the health service that gave the contract to the firm in which he was a 50% shareholder. Is that not wrong? He then resigned because of a conflict of interest and the review of maternity services was withdrawn. All of this emerged in a drip-feed of information. The matter was raised in the Seanad and in this House by Teachta Caoimhghín Ó Caoláin and by me with the Minister for Finance, Deputy Michael Noonan, who told me he had not been briefed on the matter and apologised to me privately afterwards. How is it possible that the Minister for Health did not know when he appointed the chairperson that this person had been the founder, a director and joint owner of the D & F Health Partnership? How much public money was paid to the company? What is the status of the report which recommends cuts to vital maternity services at Portiuncula, Ballinasloe and Letterkenny? Will the Taoiseach assure those living in the west and north west that existing maternity services will be retained fully? Let me give him a wee bit of advice. Why did he not come here or get the Minister to come and make a full statement instead of it having to be dragged out of him like this?

Deputy Simon Harris

Is that from experience?

The Taoiseach

Yesterday the question of maternity services was raised and it arose from a number of high profile tragic cases. It is right and proper that there be an analysis of the standards, integrity and credibility of the service. When the question was raised by Deputy Micheál Martin, the terms of reference for the analysis were published. It was remiss of me not to provide them.

Deputy Finian McGrath

The Taoiseach is waffling again and not answering the question.

The Taoiseach

The national strategy included the following issues: a population base needs assessment, with a review of current and future demand and activity-----

Deputy Gerry Adams

On a point of order, am I not entitled to an answer to my question?

An Ceann Comhairle

This is Leader's Questions. I cannot tell the Deputy what answer the Taoiseach will give.

The Taoiseach

You are. The Deputy said the report that is being prepared recommends the closure of maternity services in the west and north west. I am giving him the terms of reference set out for the report, which do not refer in any way to the closure of any of the maternity services.

Deputy Gerry Adams

I did not want the terms of reference.

An Ceann Comhairle

Please allow the Taoiseach continue.

The Taoiseach

These terms of reference are published. They are available for the Deputy or anybody else to read and nowhere in the terms of reference will one come across a recommendation for the closure of services.

The Deputy asked how much public money was spent on this report. I do not know the answer to that question, but I will have the figure on that sent to the Deputy. He referred to maternity issues. A fortnight ago, I think, I answered a question for the Deputy and told him the Minister was treating this as a matter of great seriousness, but the person recommended as chair subsequently resigned. In regard to the issues arising from the Minister's reply which remain unanswered, I will see they are answered for the Deputy. If Deputy Ó Caoláin wants to send me his particular questions, I will answer them for him.

Deputy Gerry Adams

Answer me.

An Ceann Comhairle

We are over time.

The Taoiseach

Deputy Adams is the Leader. He mentioned maternity services and wants to know how much public money has been spent on the report. I will send that information to him and will send him any other information he wants on this matter. In his own time, there are some questions the Deputy could answer that he seems reluctant to answer.

Deputy Clare Daly

I want to give the Taoiseach an insight into the vicious assault on workers' wages and conditions which is under way in this country under his stewardship. I want to draw his attention to a delegation present in the Visitors' Gallery which has a keen and personal interest in this situation - a group of workers who did not know last Tuesday morning when they tried to go to work before 7 a.m. that they would be sitting here today. They thought they would be doing what many of them have been doing for years or decades - that they would be out collecting this city's bins. Instead, when they arrived for their ten-hour shift, they were met at the door with a new clock card system. This was a bit of sideshow. They had not heard of this system, but that was not the main issue. The real agenda came after that. They were expected to sign a new contract, with a cut of over 24% in basic wages, not to mention cuts in other allowances, with immediate effect.

Let us be clear on this. These workers were not living the high life anyway. They have a modest wage as drivers and an even more modest wage as operatives. They were being asked to take a cut of between €250 and €270 per week for drivers and between €120 and €140 for operatives. How any of these workers could be expected to take a hit is beyond me. This was an orchestrated manoeuvre to undermine the unionised workers, because the employer immediately marched down to the High Court and got an injunction against them and, with the assistance of the local Intreo office, recruited people to take their jobs. The consequence of bringing people in with no training or experience was that the first truck that drove out knocked down and hospitalised Ray O'Reilly, who is in the Visitors' Gallery. The next night, another truck rammed three cars on James's Street and an ambulance and gardaí had to be called. I wonder whether there will be a fatality as a result of these antics. These unsafe practices will have far-reaching consequences.

The only way the Greyhound company can do what it is doing is by exploiting others to do the work in an illegal manner. What it is doing is making the routes longer and impossible to complete. What happens is that at 5 p.m., when the workers go home, a procurer of casual labour arrives at the car park in Woodies and, like a scene out of "On the Waterfront" selects people to work through the night to clear the bins that have not been emptied.

An Ceann Comhairle

The Deputy is over time.

Deputy Clare Daly

Is the Taoiseach going to stand by and allow practices that would be more suited to an episode of "The Sopranos" to be undertaken in this State, or will he instead immediately instruct NERA to launch an investigation into Greyhound, into the Buckley Brothers and into Gary Bogdon, the procurer of casual labour, to verify compliance with all of the State's legal, taxation and health and safety requirements?

An Ceann Comhairle

The Deputy cannot name people in the Chamber. She is over her time.

Deputy Clare Daly

Finally, will the Taoiseach instruct Dublin City Council to ensure compliance with the city's by-laws regarding the presentation of waste so that this company cannot go out in the midnight hours to use super-exploited workers to undermine decent wages?

An Ceann Comhairle

Before the Taoiseach replies, the Deputy knows there is a time limit on Leaders' Questions. I ask her to adhere to it, please. I do not want to be interrupting the Deputy, but if she goes way over her time, I am obliged to do so. Please adhere to the time limits.

The Taoiseach

It seems extraordinary that workers should be asked to take a cut of between €250 and €270 per week without any discussion or without any notice being given to them. I find it equally extraordinary that what appear to be untrained workers driving substantial trucks have been involved in the kind of incidents the Deputy has described. Clearly, the Labour Relations Commission has an opportunity to get involved here. The machinery of the State has worked exceptionally well in many difficult and sensitive circumstances over the years. I see the workers the Deputy mentioned in the Visitors' Gallery. I would expect that any company, private or public, would be amenable to the machinery of the State becoming involved in a dispute such as this. The danger arising from the incidents the Deputy has recounted is palpable. From the perspective of the Government, the capacity of the State to intervene is through the LRC and other mechanisms. I would be happy to see those mechanisms made available for these workers in respect of the company they are dealing with.

Deputy Clare Daly

I am glad to hear the Taoiseach say the circumstances are extraordinary, but what I have said is true. If the Taoiseach really means what he says, I believe there will be a follow-on from this discussion. There were discussions under way in the company and there have been three Labour Court attendances over the past 18 months, but sadly the employer has either broken or not recognised any of those decisions. Instead, it has resorted to the costly mechanism of the High Court. A case for this morning was adjourned until next Tuesday.

It is true that untrained workers are out on the streets. It is true that people nobody knows are being picked up in car parks and brought in to do the work of these unionised workers who pay tax on revenue.

An Ceann Comhairle

Will the Deputy please put her supplementary question?

Deputy Clare Daly

I want to put my question again. If the Taoiseach and all of us are appalled by what is being done, we must do something. Will the Taoiseach instruct the Minister with responsibility for jobs to get the NERA inspectors to investigate this company to see who these casual workers are, whether they are paying tax and PRSI and whether they have been trained? They are being super-exploited to undermine the work of the men who are here today.

The Taoiseach

From what the Deputy says, the situation is even more serious than that. She has recounted that one truck smashed into three cars and another truck got involved in some other kind of incident. If that is the case, are these drivers properly licensed to drive trucks of this size, or should I understand that these are people who are incompetent and unqualified to drive trucks of this scale?

The Deputy raised a fundamental point. If workers in a unionised position working for a company were not even informed of the requirement to take a drop of between €250 and €270 per week, it seems extraordinary that this was done without any consultation. The Deputy also mentioned NERA. I will see it is contacted and will also ensure that the LRC is informed of the situation. It has a tried and proven record in many sensitive cases over the years.