Dáil Éireann debate -
Tuesday, 25 Nov 2014

Vol. 859 No. 1

Leaders' Questions

Deputy Micheál Martin

I remember three or four years ago, the Taoiseach spoke in very convincing terms about dramatically reforming the health service, money following the patient, the Dutch model and the fact that everybody would be treated on time and nobody would have to wait ever again. The figures published last Friday tell a different story. One in every eight patients on a hospital waiting list is in the queue for more than one year. That is 50,000 on an outpatient waiting list for more than one year, which is a 400% increase from January to now. In Tallaght hospital alone, close to 7,000 patients have been waiting for more than one year.

In Waterford there are 6,342 waiting. The figures are bad elsewhere, with more 4,500 waiting in Galway and so forth. A total of 46,000 people have been waiting more than eight months for a hospital appointment. The Government set the eight month target, which is higher than previous ones. On the inpatient waiting lists the numbers have soared from 1,764 to approximately 9,693 in about seven months, that is an increase of 450%. There are approximately 5,000 children on an inpatient waiting list, approximately 2,000 of whom have been waiting for longer than 20 weeks, which was the target the Government set.

The National Treatment Purchase Fund, NTPF, had set a target of three months for children and six months for adults and had broadly achieved those targets across most disciplines where people required elective surgery. The former Minister for Health, Deputy Reilly, changed those targets arbitrarily. He got rid of the NTPF and there have been dishonest and flawed budgets since. In last year’s budget €200 million was taken from hospitals. There has been appalling mismanagement and there are over 200 vacancies for consultants. The Minister for Health, Deputy Varadkar, is saying it will get worse before it gets better. How much worse will it get for children and adults having to wait for hospital treatment? Does the Taoiseach accept that the commitments he personally gave three or four years ago on waiting times and lists are simply in tatters and that urgent intervention is required to turn this around?

The Taoiseach

The Deputy spoke fairly convincingly a few years ago when he said he would end waiting lists permanently. He made great play of it and subsequently accepted no responsibility for anything that happened in the Department of Health. In 2007 there were just over 6,200 on the inpatient and day care waiting lists for over 12 months. While it is nothing great to shout about, this year the number is down to 1,800 waiting longer than 12 months.

Deputy Micheál Martin

There are 50,000 waiting for more than a year.

Deputy Finian McGrath

The Taoiseach is cooking the numbers.

Deputy Micheál Martin

That is not the correct record.

Deputy Sandra McLellan

Orthopaedics is four years.

The Taoiseach

I will give the Deputy the numbers. The total number on inpatient and day care waiting lists at the end of September this year is 59,902.

Deputy Peadar Tóibín

The Taoiseach said 1,800.

Deputy Mattie McGrath

The Taoiseach said 1,800.

The Taoiseach

Of those, 9,693 adult cases have exceeded the waiting time of eight months for a procedure and 1,930 children have exceeded the paediatric target time of 20 weeks waiting for a procedure.

Deputy Micheál Martin

That is what I said.

The Taoiseach

While we cannot be happy about not meeting all the targets for children it does mean that four out of five people are receiving treatment within target times. This morning the Government approved the draft service plan submitted by the Health Service Executive, HSE, to the Minister for Health. The Deputy is aware that over €600 million has been allocated for health for 2015. There was an overrun of €510 million which will allow for some changes to be made. In September of this year the number of patients waiting in excess of 12 months for an outpatient appointment decreased from 84,167 to 41,604, a reduction of 51% when compared with the same period in 2013. Up to the end of September this year there was a 3% increase in outpatient attendances compared with 2013. That is 64,289 more patients actually seen despite the fact that expenditure in the health service has gone from €16 billion to €13 billion. Although the increased provision and uptake of outpatient appointments is positive that will result in some additional demand for inpatient and day cases. In primary care, waiting times for physiotherapists and occupational therapists has decreased and there has been an improvement in the end of life care and the childhood health surveillance.

Deputy Martin can see where the demand is coming from. In the first nine months of this year, compared with the same period in 2013, the new emergency department attendances were up by 3.5%, and admissions were up 2% including a 13% rise in overnight admissions through the acute medical assessment unit, AMAU, system. Outpatient attendances were up 3.8% as part of the outpatient waiting list initiative, facilitated in part through appointments during additional working hours. That will have an effect on elective waiting lists. These things are never as one would want them to be. I cannot project the numbers for the future, except that the changes to be made following the approval of the HSE plan by the Government this morning will have an impact on the health service in general.

Deputy Micheál Martin

I never heard the phrase “These things are never what one wants them to be” before the last general election. That was not the Taoiseach’s tone or disposition.

The Taoiseach

Nor was it Deputy Martin’s.

Deputy Micheál Martin

It was. It was much different to the Taoiseach’s.

Deputy Mattie McGrath

The Taoiseach should think of the sick people.

Deputy Ray Butler

Deputy Martin’s was forget about the past.

Deputy Micheál Martin

If the Taoiseach had left well alone things would not be as bad in the health service as they are now.

The Taoiseach

There was a €64 billion plan.

Deputy Micheál Martin

The Taoiseach knows that. That is why he got rid of Deputy Reilly as Minister for Health. The thing was a mess. It was in tatters. All I said at the outset was that the number of adults waiting for more than eight months went from 1,700 to 9,693 in adult inpatients alone. That was the target the Government imposed, although the original target was six months and the NTPF was meeting it the Government got rid of it. The same applies to children, 37% are waiting longer than the target the Government set. The real reason for that is the Government starved the Department of Health last year and brought in a false budget. I am not allowed to use the words “a lie” here but a lot of porkies about the health budget were told to Deputies 12 months ago. That is why hospitals whose budgets were cut by €200 million could not meet the impossible targets the Government set them because it starved them of funds. The Government mismanaged the consultant situation with the result that there is a serious number of vacancies across the country, in the Mater, Tallaght and elsewhere because of the mess it made of the appointments. In the health service plan the Government has just approved will that €200 million taken from acute hospital budgets last year be restored? Yes or no?

The Taoiseach

The Government approved the health service plan submitted by the HSE to the Minister for Health this morning. The Minister will outline details of the extra resources for health and how they will impact on the major areas of frontline services this week. In September the number of patients waiting over 12 months for an outpatient appointment decreased by 51% from 84,000 to 41,000. Even the Deputy, with all his knowledge and memory, cannot indicate what might arise for the health services-----

Deputy Mattie McGrath

We know what is coming down the track.

The Taoiseach

-----in the way of winter flus or vomiting bugs or whatever else.

Deputy Micheál Martin

The Government does not know.

Deputy Mattie McGrath

It is incompetence.

The Taoiseach

The Deputy never actually discovered what happened every January and February for years-----

Deputy Micheál Martin

What about the Dutch model and money follows the patient?

Deputy Mattie McGrath

Double Dutch.

The Taoiseach

-----when the system backed up because when those in the medical profession went away on winter holidays there was no theatre cover for operations to continue. That caused the back-up every year for as long as I can remember and Deputy Martin never even examined that.

Deputy John Halligan

He made the consultants work at weekends.

The Taoiseach

The medical profession would tell Deputy Martin that far more is being delivered with less because of greater efficiencies.

Deputy Micheál Martin

We actually had a system in place.

Deputy Dara Calleary

There are 9,000 on the waiting list for Galway, the Taoiseach’s regional hospital.

Deputy Barry Cowen

They can go abroad on holiday.

Deputy Mattie McGrath

They will take a holiday in Mayo.

The Taoiseach

The €600 million extra allocated for the health budget as submitted by the HSE for 2015 is now part of the programme approved by the Government today. The Minister will give the details of that later in the week.

Deputy Gerry Adams

From the outset Uisce Éireann, Irish Water has reeked of cronyism, jobs for the boys and reckless waste of public money, not least the €86 million spent on consultants. That has been a hallmark of the company. Would the Taoiseach not accept that this is a toxic brand and that the majority of citizens will not accept it?

It has also emerged that in May 2013, the Department of the Environment, Community and Local Government had an understanding that the overall budget for the installation of water meters would amount to €431 million. Instead, that has come out at €539 million, which is €100 million more than the Government budgeted for. I am sure the Taoiseach can count up that. This is a huge amount of the people's money. The CEO, Michael McNicholas, has explained this away by blaming water meter contractors. This is very interesting, given that the same Mr. McNicholas owns shares worth €1 million in a company, NTR plc - formerly National Toll Roads - which is making millions out of water meter contracts. Mr. McNicholas is also an adviser to NTR plc. Will the Taoiseach explain the massive overrun for the installation of water meters? Will he tell the Dáil whether he thinks it is satisfactory that the man who heads up Irish Water's parent company owns significant shares in a company that is set to make millions from Irish Water contracts?

The Taoiseach

I do not speak for Mr. McNicholas. He answered this question for himself very clearly yesterday. I will explain the difference between an estimate and a formal tender. Even Deputy Adams knows this. In terms of building, an estimate of what it might cost is provided. That estimate might be different from the actual formal tender that is submitted.

Deputy Mattie McGrath

How many houses could have been built with the difference?

The Taoiseach

The chief executive outlined the difference between an estimate and a formal tender.

Deputy Barry Cowen

It was an expensive consultancy.

The Taoiseach

That is the reason for the difference in the figures between the estimate and the formal tender.

Deputy Finian McGrath

Are they shovel-ready?

The Taoiseach

I might say to Deputy Adams while I am on my feet that a number of his people - at least those associated with the party he leads - were most insulting to ordinary people who attended a party meeting in Limerick last night. I am quite sure the Deputy might send a message to them. I do not believe he would condone some of the language that was directed towards women who had attended the meeting and were walking home as ordinary citizens by people who were carrying banners associated with his party. The Deputy might send them a message, please.

Deputy Gerry Adams

I will not accept the Taoiseach's word for what transpired in Limerick last night.

Deputy Patrick O'Donovan

Of course not.

Deputy Ray Butler

Blame the referee.

Deputy Patrick O'Donovan

Judge and jury.

Deputy Gerry Adams

However, let me say clearly that I stand over the principle of peaceful demonstrations which should not be insulting or threatening to anyone.

Deputy Finian McGrath

Deputy Coonan would be very interested in that.

Deputy Gerry Adams

The Taoiseach said he could not speak for Mr. McNicholas. I did not ask him to speak for Mr. McNicholas. I asked the Taoiseach to say whether he thinks it is satisfactory that the man who heads up Irish Water's parent company owns significant shares in a company that is set to make millions from Irish Water contracts. It is very simple. Does the Taoiseach accept that this is a satisfactory situation? He may also know that more than 17,000 people who returned their packs to Irish Water did so without filling them in. That was an act of peaceful and democratic protest by them against water charges. It is part of a real democratic revolution. They made it clear that they did not want to be customers of Irish Water, but Irish Water signed them up against their will in an act of extreme arrogance that was characteristic of this Government and of the company. Can the Taoiseach tell us whether the behaviour of a man who has a huge number of shares, worth €1 million, and is set to earn money from this whole project is appropriate and satisfactory? Does he believe that Irish Water's appropriation of the names and addresses of citizens who are clearly opposed to water charges, in order to sign them up for water charges, is legitimate or fair? Would it even stand up to Irish contract law?

The Taoiseach

Obviously, the question the Taoiseach is asking me is a matter for Ervia. Mr. McNicholas has stated that he had declared that he had shares in NTR. He declared his interest in the company quite openly.

Deputy Gerry Adams

I am asking for the Taoiseach's views.

The Taoiseach

He also excused himself from any commercial or contractual dealings with Celtic Anglian Water, as required under the Ervia code of conduct. He is completely in compliance with that code. He said he would divest his shares - more than 400,000 of them - in NTR and give the proceeds to Focus Ireland.

Deputy Finian McGrath

We should take out the violins.

The Taoiseach

I note that Mr. McNicholas will step down from his role on the advisory committee of NTR to ensure there is no appearance of conflict of interest.

Deputy Gerry Adams

So it is okay.

The Taoiseach

I welcome his commitment to building public confidence in Irish Water and to ensuring there are appropriate governance structures within the utility. As Deputy Adams knows, the Government is taking steps to strengthen the governance of Irish Water to improve public confidence in the utility. A single unitary board for the Ervia group is being established, with new members chosen for their particular competence and expertise. I hope the Government has responded to the legitimate concerns and anxieties-----

Deputy Gerry Adams

I knew all of what the Taoiseach has just told me. I asked for his opinions.

The Taoiseach

-----expressed by the people about PPS numbers, call-out charges and bonus regimes.

Deputy Finian McGrath

Will Deputy Coonan withdraw his remarks about the people of Dublin?

An Ceann Comhairle

Sorry, please.

The Taoiseach

I hope all of these issues have been dealt with fairly, clearly and with certainty.

Deputy Gerry Adams

Will the Taoiseach answer my questions?

Deputy Finian McGrath

Deputy Coonan should withdraw his remarks now.

The Taoiseach

I remind Deputy Adams that the contribution being requested of single people living on their own or with children under the age of 18 is €1.15 a week.

Deputy Gerry Adams

Answer the question.

The Taoiseach

The charge that a household of two adults or more will be asked to pay is €3 a week.

Deputy Peadar Tóibín

Irrespective of income.

Deputy John Halligan

People do not want to pay.

The Taoiseach

Deputy Adams regularly refers to meters. Obviously, when meters are installed, they give people an opportunity to conserve water and beat the cap.

Deputy Róisín Shortall

They do not.

Deputy Mattie McGrath

People cannot beat the cap.

The Taoiseach

Meters also provide an opportunity to determine where leaks are.

Deputy Róisín Shortall

There is no beating the cap.

The Taoiseach

The more leaks that are fixed, the less treated water goes to waste.

Deputy Peadar Tóibín

The meters are the electronic voting machines of this Government.

The Taoiseach

That, in turn, will lead to a reduction in the cost to be met by the public when that water is being provided in the first place. Obviously, a comprehensive metering programme will have a much more effective and efficient infrastructure to deliver high-quality water to businesses and consumers all over the country.

Deputy Maureen O'Sullivan

I have an opportunity now to put the question I was about to put last Thursday week when circumstances overtook us.

Deputy Finian McGrath

Hear, hear.

Deputy Maureen O'Sullivan

Last October, Pobal published on its website details of the funding that was available in different lots under the social inclusion and community activation programmes. It seemed that the level of cuts being proposed was 10% in rural areas, 20% in urban areas and 38% in areas of inner-city Dublin. This 38% cut will affect communities of extreme deprivation, which have rates of unemployment much higher than the national average, high numbers of lone families and issues presented by the new communities. I am talking about areas of greater disadvantage than other parts of the country. Even though progress is being made with educational attainment, progression to third level in these areas is much lower than in the rest of the country. These areas have lost the public private partnerships and the regeneration it was hoped would result from such partnerships. This 38% cut will affect community organisations that are offering community training and education, working with lone-parent families, providing affordable child care and working with people in addiction. I will give an example of the new realities with which these organisations are dealing. A cheap synthetic drug known as ice that came on the market recently has led to a number of deaths. The community organisations are responding to those issues as they arise.

For some reason, the Government has decided to go ahead with private procurement of the social inclusion programmes. This could have devastating effects because of the loss of expertise and experience. The 38% cut I have mentioned will be also devastating. I would like to mention a particular statistic that has been highlighted by these groups. They have said that more than 2,500 people - long-term unemployed adults, vulnerable adults, lone parents and those in recovery - could be affected by service changes in the areas of adult education and training and pre-employment support. The Minister, Deputy Kelly, has committed to the retention of community services through the social inclusion community activation programme with a loss of €1.7 million. When it is added up, it seems to be nearer to €9 million. The groups were promised that they would see the rationale allocation model. I ask the Taoiseach to ensure that will happen. How can these community organisations proceed and make progress if they are to face cuts of 38%?

Deputy Finian McGrath

Hear, hear.

The Taoiseach

The Minister, Deputy Kelly, is aware of the issue the Deputy has raised. He has undertaken to examine the funding of community organisations and entities like those mentioned by the Deputy. It is often necessary to draw funding from various State agencies for these kinds of communities or organisations. As the Deputy knows, a Private Members' motion on the question of social inclusion has been tabled today. I think the Department of Social Protection has worked very hard at that over the years. I refer to the different facilities, contributions and opportunities it has put together.

I would point out to the Deputy as well that the new board of SOLAS, in giving its remuneration to replace FÁS, has a remit to have a link between education and job opportunities.

Deputy John Halligan

Come on.

The Taoiseach

I agree with Deputy Maureen O'Sullivan that the participation in third level institutions from areas of deprivation or areas that are certainly socially challenged has been very low. We have tried to encourage third level institutions to make a particular effort so that young people would have the opportunity to go to third level, though the difficulties that they have encountered have been exceptional at second level. It is an issue that I expect that the Minister, Deputy Kelly, will probably address in the course of the Private Members' discussions this evening and tomorrow. I will bring the Deputy's personal observations to his attention myself.

Deputy Maureen O'Sullivan

I am struck by a couple of ironies. One is that the social inclusion programme is targeting those in society with whom these community organisations are working. When I was in the GPO for the launch of the 1916 commemoration programme, I was also struck by how it was not a stone's throw from some of the really disadvantaged communities. If the Rising was about anything, it was about equality.

Deputy Finian McGrath

Hear, hear.

Deputy Maureen O'Sullivan

However, this is not equality. It is also not an issue that is confined to Dublin. Last week, I attended a meeting for the non-Gaeltacht island communities. Their community development programme is facing what will almost be a complete axing, undermining their front-line services. Deputy Halligan has just told me about a child care centre in a RAPID area in Waterford that provides low-cost child care for more than 100 children. Fourteen of its employees are on protective notice. Seemingly, there is a similar case in Sligo. While I am particularly concerned with Dublin, this issue arises elsewhere. It is causing the organisations in question a great deal of stress and distress.

The Minister, Deputy Kelly, is holding a number of meetings. For example, the Minister for Transport, Tourism and Sport, Deputy Donohoe, will meet him and the Lord Mayor of Dublin has stated that he will be meeting him. However, it is more important that the Minister meet the community organisations that are on the front line of these cuts.

Deputies

Hear, hear.

Deputy Finian McGrath

Hear the real story.

Deputy Maureen O'Sullivan

Will the Taoiseach stress upon the Minister the importance of such meetings?

The Taoiseach

I actually spoke to the Lord Mayor myself recently about some matters relating to this. No more than the Deputy's good self, he is well acquainted with the difficulties in a number of communities here in Dublin in particular. Obviously, island communities have had a particular priority over the years. There is a €2.2 billion fund for rural development between 2014 and 2020 that covers a lot of the areas and the different organisations out there.

Deputy Thomas Pringle

Not any more.

The Taoiseach

Deputy Halligan has raised with Deputy Maureen O'Sullivan the question of the child care centre in Waterford. For instance, non-commercial or community-run centres, obviously, were derated recently by the Department of Public Expenditure and Reform to lessen the charge there.

Deputy Mattie McGrath

Like the Irish Water buildings.

The Taoiseach

It is actually more important that the Minister look at what the overall result might be here. I cannot speak for his diary, but I know that he is aware of this and has already undertaken to look at it.

Deputy John Halligan

These are RAPID areas to which the Government committed its support. The Government is abandoning them all over the country.

The Taoiseach

Perhaps if Deputy Halligan wants to give me the details of the centre in Waterford, which I am not acquainted with,-----

Deputy Mattie McGrath

The Government has no interest in them.

Deputy Róisín Shortall

The same is happening everywhere in the country.

An Ceann Comhairle

Deputies, please.

A Deputy

There is no Fine Gael vote in it.

Deputy Finian McGrath

We are not talking about giving away huge amounts of money.

The Taoiseach

-----I would be happy to have a response provided for the Deputy.

Deputy Róisín Shortall

The Government is decimating the community.

Deputy John Halligan

Seven or eight jobs will go and children will be abandoned in a RAPID area.

Deputy Mattie McGrath

The Taoiseach should ask his backbenchers.

An Ceann Comhairle

Would the Deputies ever stay quiet, please, until the Taoiseach has answered the question?

The Taoiseach

I would be happy-----

Deputy John Halligan

It is a RAPID area that the Government claimed it would support. This is outrageous.

An Ceann Comhairle

I am sorry, Deputy Halligan, but this is Deputy Maureen O'Sullivan's question.

Deputy Finian McGrath

He was waffling on again.

The Taoiseach

I would be happy to have a response provided for Deputy Halligan and Deputy Maureen O'Sullivan, if they wish.

(Interruptions).

Deputy Finian McGrath

The health committee was very quiet on the last question.

An Ceann Comhairle

We now move on to Questions to the Taoiseach.

Deputy Finian McGrath

"Democratic revolution."

Deputy Jerry Buttimer

We brought about the change, Finian.

An Ceann Comhairle

Will Deputies stop shouting across the Chamber, please?

Deputy John Halligan

I do not think the Government understands what a RAPID area is. It has given up on the less well-off in society. That is what has happened. There is no point in passing smart remarks across the floor.

An Ceann Comhairle

Will the Deputy please stay quiet? Thank you.

Deputy John Halligan

People are losing their jobs all over the country in other RAPID areas that the Government is supposed to be supporting.