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Dáil Éireann debate -
Wednesday, 6 Jul 2016

Vol. 916 No. 3

Leaders' Questions

Before proceeding to take Leaders' Questions under Standing Order 29, I point out to Members that yesterday we ran significantly over time and that overrun has implications for the transaction of business in the rest of the Dáil. I ask Members in this section to have regard to the time allowed. I call Deputy Micheál Martin.

I want to raise with the Taoiseach today the appalling length of the waiting lists and waiting times in the hospitals for patients throughout the country. The situation is truly scandalous and is unacceptable, particularly for children who are waiting far too long to get to see a consultant in the three children's hospitals, especially in Crumlin and in Temple Street.

One can trace it back to the decision of the then Minister, now Senator James Reilly, in 2011 to mothball and destroy the work of the National Treatment Purchase Fund. Prior to that, the average waiting times for elective patients was approximately two and a half months for those waiting for elective treatments. Senator Reilly changed the system - it is all documented - and it has been all downhill since with dramatic increases in waiting times and in the waiting lists. For example, we now have 415,000 people waiting for outpatient appointments and 62,000 people waiting longer than one year. We have in excess of 75,000 people waiting for inpatient treatment in hospitals. Some 4,500 children are waiting for appointments in the three children's hospitals, 2,000 of whom are waiting for more than a year. One would think that when it comes to children, we should be moving might and main to eradicate or shorten dramatically those waiting times, particularly in terms of those waiting longer than a year.

The programme for Government talks about progress and sustaining progress made. I would suggest that the Taoiseach should take out the language of sustaining progress because no progress has been made over recent years in terms of waiting lists and, in fact, the situation has become dramatically worse. The waiting lists are now up 45% in two years. It is a sad indictment of what has been going on over the past two to three years in terms of policy initiative and a lack of basic urgency in dealing with this crisis. Patients, in particular children, should not have to wait that long to get to see a consultant.

There is a commitment, involving €15 million, to re-establish the treatment purchase fund. The €15 million will not be enough. There is a wider commitment of €35 million, or €50 million overall, in terms of waiting lists. Will the Taoiseach outline to the House the plans to reconstruct and re-establish the treatment purchase fund back to the model that was in existence before Senator James Reilly mothballed it in order that it would be effective and have the capacity to deliver the results?

Does the Taoiseach accept these waiting times are absolutely unacceptable for the patients concerned?

I accept that any waiting list is never satisfactory because the patient must wait. As Deputy Martin pointed out, the programme for Government emphasises the need for a sustained commitment to improve waiting lists for patients, with a particular focus on those who have had to wait longest. The Department of Health will engage with the National Treatment Purchase Fund to deliver on that €15 million funding for an initiative targeted at those waiting the longest, with the continuing investment of €50 million per year to deal with waiting lists. I understand the Department is currently engaged with the National Treatment Purchase Fund and the Health Service Executive, HSE, is planning a dedicated waiting list initiative to be rolled out later this year.

The issue for patients is how long they must wait. Improving waiting times for scheduled or planned care for patients is absolutely key. The action taken by the previous Minister resulted in improvements. In 2015, some €51 million in additional funding was provided to address maximum waiting times of 18 months by 30 June and 15 months by year-end for inpatient, day and outpatient cases. The end of 2015 demonstrated a 95% achievement for inpatient and day case waiting lists and a 93% improvement for outpatient waiting lists against the 15 months maximum wait times. This year, the HSE service plan undertakes to maintain the 2015 levels of service in respect of scheduled care.

In 2016, the HSE's scheduled care governance group is focusing on a number of key areas, including ensuring that the chronological scheduling of cases is adhered to, putting in place validation procedures to ensure patients are available for treatment when they are deemed to be for treatment and relocating high-volume low-complexity surgeries to smaller hospitals. Many consultants have said to me they could do more work if some procedures of lower complexity were shifted to smaller hospitals. The group is also focusing on designating an improvement lead for each hospital group to provide support in meeting the national targets both for appointments and treatments.

There is an extra €800 million in the health system because the state of the economy has improved and that, in turn, will lead to improvements in a number of sectors. That money was not available before to deal with these very necessary cases.

That is not actually the case; the former Minister, Senator James Reilly, changed the policy. He got rid of the treatment purchase fund, which was a singular, dedicated and focused approach to dealing with waiting times. He blew it and got it terribly wrong. Another Minister, Deputy Varadkar, came after him and demonstrated no urgency at all on this. There are 5,000 patients waiting in Beaumont, meaning the numbers are up 57% on January this year. The Government must have a real check on reality and not quote the kind of figures I mentioned. The former Minister, Senator James Reilly, created a new target of 12 months - plucked from thin air - and up to then the target was six months for adults and three months for children. The former Minister, Deputy Varadkar, put it at 15 months. The Government could then judge against new targets that it created.

This is an urgent issue for the number of people who are waiting for procedures. In Crumlin's children's hospital, 2,000 children have been waiting for more than a year for an outpatient appointment. That is not good enough. We should immediately tackle that with a sense of urgency followed by real money now and not later in the year. We must get to the bottom of it. The numbers is Waterford are up 183% since January.

The Deputy's time is up.

That is the second-worst in the country. There are 4,000 people waiting at Cork University Hospital, which is unacceptable. This needs dramatic and urgent action by the Minister, with a proper re-establishment of the treatment purchase fund.

There should be a dedicated approach to getting the issue sorted. It is getting worse as time goes on.

As I said to Deputy Martin, the original allocation included €300 million extra for health. That has been adjusted with a further €500 million. The National Treatment Purchase Fund was discussed between the two parties in respect of the formation of Government and Deputy Martin himself, in fairness, made the point that it should be restored. It is being restored and the discussions are ongoing at the moment between the HSE and the National Treatment Purchase Fund for the roll-out of treating people on a dedicated waiting list, with €15 million allocated for it this year. Obviously, any figure is never enough when compared to the requirements in health, but there is a need here for outcomes and for results. The National Treatment Purchase Fund is now being put back in situ. Discussions are ongoing between the HSE and the National Treatment Purchase Fund for an initiative that is targeted at those who are longest on the waiting list. I hope that will produce good results for those patients in the very near future.

The Taoiseach's Government, aided and abetted by the Fianna Fáil Party, is stumbling from crisis to crisis. There is a calamity in our health system and there is a homelessness and housing crisis that is spiralling further out of control by the day. Citizens are being crippled by a cost of living crisis in rents, mortgages, child care, property tax and car insurance. To make matters worse, there is the aftermath of the Brexit referendum and the challenges that presents across the island. I am sure the Taoiseach now realises that his handling of the proposal for an all-Ireland forum, a national forum, was clumsy and incompetent.

Just yesterday, the chairperson of the expert commission on water charges, Mr. Joe O'Toole, resigned. The Taoiseach's Government is a mess and the Fianna Fáil leadership is a willing partner in all of this. It has obliged him at every turn, or every U-turn, because the Fianna Fáil Party has done a U-turn on every issue, from saying it would not support Fine Gael in government to water charges, bin charges, NAMA, the national monument on Moore Street, rent certainty and, just last night, banded hours contracts. None of this is in the common good. None of it is in the national interest. It is motivated by the Fianna Fáil leadership's desire to keep Fine Gael in government until it decides to pull the plug at the point most advantageous to itself and its ambition to form a government. There is no other reason for the Fianna Fáil Party's behaviour. It is all about political power. It is not about new politics. It is nothing but the same old story.

The commission on water charges is clearly only a committee to provide the Government and the Fianna Fáil Party with a fig leaf on water charges as part of this partnership Government. Joe O'Toole put it well when he said: "People voted a certain way, Leinster House is not prepared to grasp that particular nettle, so we have to find a solution that will have enough sugar on it to make the medicine go down easily." However, Leinster House has not been allowed to deal with this issue. The public has rejected water charges.

It is Leinster House now, is it?

They should be scrapped and dealt with here in the Dáil, democratically and decisively. Here is the chance to get something done in this term. Let the people here, the Teachtaí Dála, vote on this issue, to scrap water charges, instead of kicking the issue down the road to an already undermined commission, or, in keeping with the fiction of new politics, does the Taoiseach have to ask an Teachta Martin for permission to do that?

I thank Deputy Adams. I note that for the first time in 40 years he actually does support something in regard to the European Union. In respect of his tirade for the last three minutes, he should have a chat with Deputy Martin himself-----

It was a wonderful compliment he gave me.

It is a cartel, a Fianna Fáil-Fine Gael cartel.

-----and walk around the quadrangle out there. Deputy Adams seems to have many issues with the Fianna Fáil Party.

Government is becoming very unpopular altogether.

It is important that we recognise-----

We do not have any army council.

-----that this is a partnership Government. This party that I lead does not have a majority and we have to rely on and co-operate with all the Members of the House and the different groupings and parties, including Deputy Adams' party.

Even Deputy Shane Ross.

That is why, under the new arrangements, he will be briefed and given information in respect of issues that are arising and that will arise, and that should be so. Deputy Adams's question today seems to be in respect of the Fianna Fáil Party.

We have put in place a process for dealing with contributions for water. The charges have been suspended for nine months and the issue will come back here for a vote by Members of this House. I have already stated my own party's views on water contributions. After a full and proper discussion on all these issues, Members will have a chance to vote on proposals which will come before them, hopefully within nine months.

Fianna Fáil made a very clear election manifesto commitment to scrap Irish Water and they should honour that commitment. The expert commission on water services was dreamt up to get them off the hook and Fine Gael bought into it because it needed the support of Fianna Fáil. Fianna Fáil was centrally involved in the rise and fall of Joe O'Toole and the Taoiseach has been around for long enough to know they will do exactly the same to him when it suits them.

We have real challenges after the Brexit vote, in addition to the crisis in homelessness and the health services, and that is where the Taoiseach's focus should be. I wish him well in that but he should work with everybody in this House in a real way for the benefit of the people of the island of Ireland, instead of piddling about with Fianna Fáil and doing little side deals in order to remain as Taoiseach

Does the Deputy have a question?

Let us have some really new politics. Let us decide to scrap water charges today by putting a motion to the Dáil to relieve households of this punitive tax.

I am glad that the Deputy leader of Sinn Féin, Deputy Mary Lou McDonald, was able to tell me today, during discussions on the north inner city, that she and the group with whom she has been working will bring forward their terms of reference and that we will be able to proceed to set up an entity that will work with all the groups in the inner city, including Sinn Féin and other parties and community groups, for the betterment of the people there.

Wednesday seems to be anti-Fianna Fáil day.

That is every day.

The Brexit vote, concerns about our relationship with the UK, in particular on the common travel area and an open border, the need to maintain the improving trade links we have with the UK and the importance of being at negotiations when they commence, while maintaining our close links with the European Union, are important matters for us all and we will engage with anybody.

What is the Taoiseach's price?

I have had a lot of contact with people who export to and from Northern Ireland, and from here to Britain. I have heard their views and am considering how they might be taken into account. I will certainly follow through on that.

The Taoiseach did not even start to answer the question.

Can the Taoiseach explain the rationale that led the Government, yesterday, to approve the gap-funded model for delivering broadband? This will entail a 26-year contract with private providers, at the end of which the networks will be privately owned. The reasons publicly given for the decision were that this would be cheaper than direct State funding and would be off balance sheet so as to free up capital spending elsewhere. We have poor broadband in this country, particularly in rural areas, because of the decision by Fianna Fáil to privatise Eircom in the biggest economic mistake this country made until Fianna Fáil's even more disastrous mistake in giving the blanket bank guarantee in 2008. This Government is about to repeat that mistake. Just as the State was ultimately required to buy back the West Link toll bridge for €600 million, ensuring that the private company, National Toll Roads, received a staggering €1.15 billion return on its investment of €35 million to build the bridge, as estimated by the Department of the Environment, Community and Local Government, we will ultimately have to reacquire the broadband infrastructure in exactly the same way.

Fine Gael agreed with the Labour Party that vital infrastructure networks, such as the electricity and gas distribution networks, should be kept in public ownership. We came to that agreement over the past five years, albeit after a battle, but now that understanding of the importance of the distribution systems for a vital resource seems to be gone.

As the Taoiseach knows, the previous Government had two options when we decided this last December. One was the model he decided on yesterday, the so-called gap funding model, or a full concession model whereby the asset, after the 25 years, came back into public ownership. Will the Taoiseach accept that yesterday's decision is short termism and not in the public interest? Will he agree that all relevant documentation and all the advice given to Government on this matter should be laid before this House in order that we can make a collective determination before this matter is finalised?

We do not intend to repeat what happened with Eircom. This is not a publicly owned system. What is involved is extending broadband for the last mile to many businesses and houses in areas throughout the country that are deemed not to be commercially viable. It is an extension of the existing system. It is not a national publicly owned entity like the Eircom network. That is the first point.

The second point is that a choice has to be made. If we leave a situation where the State takes over the assets after 25 years, there is no incentive on whatever company or companies that own that system, from the tenth or 15th year onwards, to upgrade it, keep it in good shape and have it ready for handing over to the State. Why would they?

The intention is to be able to provide more than 750,000 individual premises with high quality, high speed broadband. That will deal with 100,000 kilometres of road network and 96% of the land mass of the country. That is what is involved here. It is anticipated that a contract will be awarded in 2017.

Deputy Howlin was an esteemed member of the Government dealing with public expenditure and reform and he knows that the choices to be made are always difficult, but in terms of the choice here, if we go for a fully owned public model, as the Deputy points out, the efficiency and the reduction in costs in the gap model adopted by Government yesterday on the recommendation of the Minister for Communications, Energy and Natural Resources allows for serious sums of money to be spent on other issues like schools, primary care centres, hospitals and so on. That is a choice that has to be made, and the Government made its choice clearly, but I repeat that this is not a national publicly owned entity. This is an extension of privately owned facilities, and for that reason, the Government came down on the side of the gap funding model proposed by the Minister for Communications, Energy and Natural Resources which will result, by independent regulation, in premises and businesses having access to that during and after the 25-year period but also to allow for the saving of serious sums of money that can be spent on other facilities people need throughout the country.

Nobody would dispute for a second the essential nature of rolling out broadband. That is why it features so heavily in the capital plan the previous Government adopted. The issue is the ownership of the network. A briefing document on ownership was distributed by the Department yesterday. It was a net decision on ownership. The Taoiseach says it will not be another Eircom. I believe it will be. If it does not remain in public ownership, we will be required at some stage to take it back into public ownership.

I was fearful, when this issue was divided between two Departments, that it would not be taken as seriously as it should be. Does the Taoiseach not accept that there were two proposals to Government yesterday? The first was the commercial stimulus or gap funding model which would see private contractors having ownership of the network at the end of the 25-year period, and the second was a full concession model. The Government's document states that the asset is handed back to the State after 25 years under the second model. Why was that model not accepted?

Will the Taoiseach put all the documentation before the House so we can see the basis for the decision and in the spirit of new politics - so-called - that we can have inputs in to making the correct long-term decision for the people of Ireland?

The Deputy seems to have the documentation there, if not all of it, and I will see that the Deputy receives the rest of it. The point is that the Deputy is either mistaken or is being deliberately misleading. Deputy Howlin knows that the network is not a nationally owned public entity.

But what is going to be rolled out is.

The extension here is an extension of privately owned facilities to provide access to proper broadband speeds for 750,000 individual premises.

Financed by the taxpayer.

The choice the Government has to make, and had to make, is this: if one wanted to be a fully owned public entity after 25 years there is absolutely no incentive whatsoever on the company or companies to upgrade and improve that facility-----

A Deputy

There could be an obligation.

-----for handing over to the State in the latter part of that. The opportunity-----

-----based on the decision made by Government, on the recommendations of the Minister for Communications, Energy and Natural Resources, is one that would allow access to an upgraded and proper facility-----

Will the Taoiseach allow us to-----

-----for all those businesses-----

I thank the Taoiseach.

-----throughout the country, and at the same time allow for significant amounts of money to be available for spending in other areas that we have all been-----

I thank the Taoiseach.

-----contacted about such as schools and hospitals-----

It is short-termism.

We need to conclude Taoiseach.

-----and primary care centres, roads and facilities throughout the country. That is the choice-----

Will the Taoiseach allow the matter to be debated?

-----and the Government has made its choice.

We need to conclude. I invite Deputy Clare Daly on behalf of the Independents 4 Change.

I want to tell the Taoiseach a story. I wish it was not a true story but it is. Two sisters were both pregnant and happily looking forward to the birth of their children. Tragically, towards the end of the first sister's uneventful pregnancy, the baby died in the womb. She was medically assisted in delivering him, the family buried him and mourned him. The second sister received a diagnosis that the foetus she was carrying had a condition of fatal foetal abnormality incompatible with life. She wrote to me in the days that followed:

I do not want to terminate my baby’s life but he does not have one. A heartbeat does not equate to an independent life for my boy, it only confirms a short few hours of pain for him and a lifetime of it for us. I have watched what my sister went through, the amount of support she was offered and the support she will require over the coming months. I feel so angry that this support is not available to me. I have also watched my parents anguish, particularly my mother’s, as they take note of all this and know that their other daughter has this ahead of her without that much needed support, hundreds of miles away from family and friends. The dignity shown to the tiny corpse of my nephew in the hospital, in the mortuary and on his first and final journey home will not be extended to my son as he will have to be locked in the boot of the car on a ferry journey back across the Irish Sea or his ashes delivered by a courier weeks later, along with Amazon and eBay purchases.

This is the Taoiseach's Ireland. These events happened in the weeks after he last voted down our fatal foetal abnormalities Bill. In anybody's book it is cruel, inhuman and degrading treatment. The Government has appeared in front of international human rights bodies on four occasions since and has been instructed to deal with these matters but the Taoiseach has done nothing. In the case taken by Amanda Mellet, UN human rights experts stated that not only did Ireland violate her human rights, but the lack of action aggravated her suffering. The Taoiseach comes to the House and speaks about a citizens' assembly reporting to an Oireachtas committee, which means that it will be at least 2018 before any proposals will be before the people to remedy this, condemning hundreds of others to the torture which was experienced by Amanda Mellet. The Taoiseach hides behind the advice-----

Will the Deputy please put a question.

-----of the Attorney General, advice we have not seen and which was substantially at variance with the advice of other Attorneys General and which was disputed by an array of legal experts. Who does the Taoiseach think he is to believe he can allow the continued violation of human rights?

I thank the Deputy.

The Constitution can never be used to deal with this.

If the Taoiseach does not have the leadership or the guts to do this himself will he stop using his position to block the courts or the people from dealing with it?

These are all harrowing tales that Deputy Daly raises today. I get similar communications from women all over the country. This is our Ireland. It is an Ireland that is subject to a constitution, which is voted on by the people. In the 1980s that vote was taken by the people and the interpretation of its meaning was made by the Supreme Court. This impacts on people’s lives. I want to try to change that and in order to do that I have to build consensus, understanding and information for people who will have to vote if that be so to change the Constitution one way or the other.

It is not a case of me as a citizen standing here, blocking anything. We have put into the programme for Government a process which can be gone through rationally and in a common sense way, taking into account the changing attitudes and the sensitivities of so many people. The Deputy may not appreciate that. I understand her point of view. She has been very forthright about it. She has stated her views here very cogently on many occasions. Unfortunately for her, she cannot change the Constitution unless she has the opportunity to cast her vote along with the citizens. For that reason the process I have set out is one that will return here to the legislators elected by the people to cast their vote in a free way, according to their consciences. If that recommendation is for a referendum to deal with the eighth amendment in whatever form then so be it, that vote will take place and that is the only way it can be changed. While the Attorney General, as I told Deputy Howlin yesterday, is the only legal adviser to the Government under the Constitution, I accept that. It is of course the Supreme Court at the end of the day which interprets what the Constitution means. I have included as a central part of the programme for Government the citizens' assembly and a reflection in the first instance on the eighth amendment, taking into account many of the stories the Deputy has outlined and reference back to the Oireachtas.

While Deputy Daly has been forthright here, according to the medical assessments of what is contained in Deputy Wallace’s Bill it will not be touched by any medic in the country. This Bill is not good for women: it is bad for women. It is inadequate and that means that it does not answer the question the good lady asked in her letter to the Deputy. I have set out a process by which collectively we can reflect on this and eventually the people might be asked to make a decision. That is the only way the Deputy’s Constitution can be amended or changed. I do share Deputy Daly’s view that the services surrounding these events and instances should be improved. We want to make arrangements that it be so. The central issue is that if a child is born for whatever short length of time Article 40.3.3o kicks in and that is the challenge. That is what needs to be talked about and understood. That is why those at the top of the medical profession say that while Deputy Wallace might have the principle right in the Bill, the substance and the way it is phrased are grossly and wholly inadequate.

The Taoiseach does not stand here as a private citizen but as the leader of a country that has been found to violate the human rights of women. When we did try to put to the House the proposal that there would be a repeal of the amendment to the Constitution to provide for abortion in this and other circumstances, the Taoiseach and his Government stood in its way. He has used his position to block progress on this. The arrogance of the Minister for Social Protection, Deputy Varadkar, and several of his colleagues, who would presume to anticipate how the courts would deal with this matter, is absolutely breathtaking. The Taoiseach’s use of the Attorney General as a block is in and of itself unconstitutional in my opinion. The Government proposes laws, the Dáil passes laws and the courts interpret laws. Why can the Taoiseach not allow the courts of our country adjudicate on this? We have not seen the Attorney General’s advice but from the titbits we get, and the Taoiseach seems to have reiterated it, her advice seems to rest on the mistaken premise that Article 40.3.3o deals only with cases where there is a risk to the life of the mother.

That is not true. PP v. HSE, Roche v. Roche and in re A Ward of Court did not deal with those circumstances. She seems to be saying-----

Your time is up.

The Taoiseach went well over his time. I was watching the clock on this.

You have gone over your time too.

Maybe he could assist us by publishing the advice of the Attorney General. He is the one who stopped the people and courts deciding on this, and his diktat to his backbenchers to obstruct this Bill is condemning hundreds of people to the continuation of torture because what he has proposed is nothing.

Deputy Daly is wrong again. We legislated for the interpretation of the Supreme Court in the Protection of Life During Pregnancy Act after 30 years of failure and neglect by any Government to deal with or legislate for this issue. The Deputy said I did nothing about it, but a central part of the programme for Government contains a process by which we can look and reflect carefully on the eighth amendment and what it means. The citizens assembly will examine it in the first instance and report back to the Oireachtas.

The Deputy may not believe in or want that process, but it is something that is a way to look at the eighth amendment and its ramifications for the many women who have had to deal with trauma, stress and pressure. I agree that the services that should be provided for people can be improved. The central issue of the substance of Article 40.3.3° is one that is part of the process we have put in place.