Leaders' Questions

The revelations in yesterday's The Irish Times of the correspondence between the chief executive officer of the Health Service Executive and the Minister and the Department of Health demonstrate a very flawed and essentially opaque approach to the funding of our health services. At the very least, they show a very poor sticking plaster is being applied. There is a complete lack of transparency, substance and, most worryingly of all, credibility surrounding these figures. There is a bogus, spurious element to some of them and, indeed, a clear statement in the correspondence that they will not translate into reality. With all the talk of the implementation of Sláintecare, the crisis in accident and emergency services, overcrowding, and the bed capacity review, in essence these figures and the correspondence between the HSE and the Minister show that the health service will at the very best stand still if not face more cuts to vital services in 2018. Given that the pay agreements will absorb the bulk of the increased expenditure, there will be little for additional services. The elderly will continue to suffer, the disabled will still be shortchanged in respect of access to therapies and services, the acute hospitals will remain under intense pressure, notwithstanding the experiences of December and January, and primary and community care will remain neglected.

Specifically, according to the HSE's own internal assessment, there are "long waiting lists" in respect of gynaecology and "poor access to treatment [has] left thousands of women with a poor quality of life". Regarding anaesthesia, the HSE states that "Serious clinical risk exists because [there is only] one line of anaesthetic call" in most general hospitals and accident and emergency departments. The HSE states that there is "a national shortage of critical care beds" which is "impacting on access to scheduled and unscheduled care services". Ophthalmology theatre closures and waiting lists are "affecting preventable deterioration". Urgent targets will be missed in endoscopy and colonoscopy. There will be a staffing deficit in 2018 right across the spectrum of cancer care for child and adolescents and in geriatric oncology, radiation and surgical and medical services. The correspondence goes into other specifics, such as the need for 80 beds and five theatres in Our Lady of Lourdes Hospital, the dialysis unit in Galway and so on.

Most damning of all, the so-called value improvements or cost savings have not been identified and are extremely vague. The chief executive is stating large tranches of these savings will be very difficult to realise and, if we read the language, will not be realised.

Does the Taoiseach agree these Estimates lacked transparency in advance of the budget and have lacked it since and, in essence, they mask a deteriorating situation in the provision of services to our citizens in 2018?

Before calling the Taoiseach to respond, I ask Members to extend a warm welcome to our distinguished visitors, the Moderator of the Presbyterian Church in Ireland, Dr. Noble McNeely, who is accompanied by the Clerk of the General Assembly, the Rev. Trevor Gribben, and our friend from Lucan, the Rev. Trevor Morrow.

It is important that when we discuss health budgets we put all of these things into their rightful context. We have this year the largest budget for the HSE and the health sector in the history of the State, at approximately €15 billion, an increase of €2 billion a year in the past three years. It is increasing much faster than the population is growing or ageing. We are now one of the top five spenders on health in the world, if we divide the health budget by the number of citizens in the State, notwithstanding the fact we have a young population. Even during the recession, our health spending per capita was above average, so this idea we are only catching up on underspending during the recession is not supported by the facts.

The fundamental problem and crisis that affects our health service, in my view, is not solely lack of money or lack of resources. It is much more about how money is spent and how resources are deployed, and monetising all problems does not actually bring us any closer to a solution. There will, of course, be more money and more staff for the health service this year. We already have record numbers of doctors, almost 10,000, working in our public health service. In terms of nurses per head or per bed, we are very near the top of the league table. However, those extra staff and extra beds, and all of the extra money, will not make a difference unless we have better management, proper clinical leadership, real accountability and proper responsibility from those charged with running and managing our health service. I absolutely accept it is the Government's responsibility to make all of this happen.

If we take the entire spend of the entire Government, we spend approximately €60 billion a year. In a sustainable way, the most any responsible Government can increase spending is by approximately 4% or 5% a year. Anything more than this is unsustainable and we would be heading into another crisis quite soon. The most we can increase spending is by €2 billion or €3 billion a year. If we take all Government Departments and agencies together, they requested an extra €12 billion this year. Anyone will understand this is not sustainable. It is the normal process in the course of events for Departments and State agencies to request much more than they anticipate they will achieve from the Estimates process.

What is unique about the HSE is it estimates it needs €1.5 billion extra every year, that is, an extra 10% to do nothing to improve patient outcomes. That is not sustainable. If we are going to turn around our health service and make reforms and changes, and if we have any prospect of implementing reports such as the Sláintecare report, the starting point cannot be a 10% increase in the budget, an extra €1.5 billion a year, to do nothing to improve outcomes for patients, patient experience or patient care. It is not credible or sustainable, and I accept it needs to change, because we cannot have this continual exchange of letters where all problems are monetised and then just passed on. We will need a lot of changes and a lot more accountability, and that will be driven by the Government.

The Taoiseach did not answer the question. My question went to the heart of an issue of credibility and honesty in presenting the figures and challenges facing the health service. The Taoiseach has been commentating on the health service since he was Minister for Health, with little outcome. In 2014 and 2015, I identified dishonesty in the health service Estimates process and in the way things were working and operating in the Department and the HSE. Essentially, I am asking the Taoiseach whether the Estimate put before us in the national service plan, is acceptable. Irrespective of all of those issues about which the Taoiseach has spoken, one cannot put figures that cannot be realised into an Estimate.

That is what the chief executive of the HSE is telling the Government and the Oireachtas at this late stage, after the budget has been passed. In essence, the indication is that there is potentially a deficit of €800 million. Leaving that aside, there is a figure of €346 million for efficiency savings or value improvement. He is very clearly saying that the last element of that is almost beyond implementation in the figures. Essentially, he is saying that delivery of the €119 million in priority theme two, in addition to the €77 million from priority theme one, will be extremely challenging. We all know what that means; it means it is a false figure and it should not be in there.

Let us have an honest debate about this issue. The Taoiseach should stop coming in and saying that the Government will implement Sláintecare; it is not going to implement Sláintecare or anything in Sláintecare. That is the honest answer. Let us have an honest debate about the challenges facing health not just on funding, but on reforms. Let us not camouflage, mask and pretend while putting a sticking plaster over the figures for another year. That has been happening for the past four years. The Government realised hundreds of millions of euro in other savings last year while getting additional tax and so on but it has also prioritised where that goes. We want an honest debate on the figures not after the budget, but in advance of it.

I always welcome an honest debate and if we were to have an honest debate about health, one of the first elements the Deputy would accept is that it is not credible or sustainable to argue for an extra €1.5 billion per year for health care on the basis of it making absolutely no difference, with no improvements for patients.

We know that. That is not my question.

There is no chance of resolving our problems if they are all monetised and it takes an extra 10% per year to do nothing at all.

That is not the question I asked. Does the Taoiseach stand over the figures?

The position is not credible. With respect to the Deputy, it is fair to say he has been commentating on the health service for a very long time, since he became a Member of the Dáil almost 30 years ago, and including a period as a health Minister. He knows that during his period in government, there were service plans that included efficiency criteria and percentages for efficiency. There is nothing unusual about that.

In more general terms, there will not be cuts to the health service in 2018. The budget has increased and staffing levels have increased. All problems will certainly not be solved but there will be action in a number of very important areas. For example, there will be an increase in funding for home care, with an extra 75,000 hours for that care. It is very real. Surgical waiting lists have been falling for most of the past six months because of investment in elective hospitals and investment through the National Treatment Purchase Fund. That will continue. We are also adding more beds to the system, with 170 additional beds opening so far this winter across a number of hospitals. I would be happy to list them.

I especially welcome our visitors and it is good to see friendly faces. The Taoiseach knows another round of talks to re-establish the political institutions will start tomorrow in Belfast. This will be the fifth round of formal talks since the power-sharing arrangements collapsed a year ago. There have also been numerous informal and private exchanges between Sinn Féin and the other parties, including the Democratic Unionist Party, mostly on Michelle O'Neill's initiative. The institutions need to be re-established on the basis of equality and parity of esteem. Thus far, the Democratic Unionist Party leadership has resisted this imperative, and there is no doubt elements of that leadership are encouraged by the pact it has with the Tory Government in London.

Many people in the North were pleased with the Taoiseach's recent assertion that nationalists will never again be left behind by an Irish Government, so his recent remarks on Clare FM were very disappointing. This type of negative commentary has long been the hallmark of statements about the North from leaders in the South. These include the Taoiseach's predecessor and the Fianna Fáil leader, who along with others present the difficulties as the fault of two problem parties. The Taoiseach should try to avoid that temptation. Whatever effect this negative approach has in elections here, it is certainly of no assistance to the talks process in the North.

The Taoiseach is well aware of the issues, which concern rights. In essence, all the rights being denied to people at this time are rights available to everybody else on these islands. In his Clare FM interview, the Taoiseach stated that Sinn Féin is incapable of negotiating and compromising in the North. This raises the question for the Taoiseach as to what rights should be compromised. Perhaps Gaeilgeóirí should forget about an Irish language Act or gay and lesbian couples should forget about marriage equality or the bill of rights. These are not the questions I am asking today.

Instead, I actively encourage the Taoiseach to continue to meet people in the North, outside the political parties, to get a deeper sense of what is happening there.

I have recorded my concern about the toxic atmosphere that has shrouded political discourse in recent times. However, I welcome the announcement this morning by the group describing itself as Óglaigh na hÉireann that it has ended its armed actions. I especially thank and commend the trade unionists and community leaders who were involved in securing this outcome. Meaningful change can only be managed and advanced through exclusively peaceful means. That is Sinn Féin's commitment and our record is there to see. Martin McGuinness's letter of resignation is very clear about what must be done. Grassroots opinion is also quite clear. Will the Taoiseach recommit to engage energetically and consistently with the British Prime Minister to uphold the Good Friday Agreement and to help to get the political institutions restored as soon as possible?

I join Deputy Adams in welcoming the announcement by the group styled as Óglaigh na hÉireann of its decision to end violence. I also recognise the involvement of trade union leaders, politicians and others in that engagement.

The Government, with the new British Secretary of State for Northern Ireland, has initiated a new series of talks between the parties in Northern Ireland. That will be facilitated by the two Governments and we will be strongly engaged in it, acting in our role as co-guarantors of the Good Friday Agreement. Indeed, the Tánaiste and Minister for Foreign Affairs and Trade, Deputy Coveney, will be in Belfast tomorrow with the Secretary of State and will engage urgently with all the parties to seek a way forward. Contact has also been made between the Prime Minister, Mrs. May's, office and mine. Both of us will be attending the same conference this week and perhaps will have an opportunity to speak there. In that context I will emphasise my commitment to the talks process and to getting the Assembly and the Executive back up and running, which all of us wish to see happen. Certainly, if personal engagement by me and the Prime Minister will make a difference, we will be happy to provide that. We have made that commitment in the past.

In terms of Irish citizens in Northern Ireland and nationalist people who consider themselves to be Irish not being left behind, that is something I said and meant. I will follow up on it by meeting non-political people and leaders from civic society in Northern Ireland in the weeks and months ahead. I hold the view that there is no right that anyone enjoys in Ireland or Britain that should not be afforded to people of both communities in Northern Ireland. People in Ireland and in Britain can marry their same-sex partners and there is no reason that Northern Ireland should be an exception in this regard. The same applies to issues such as language legislation and language rights. If these apply in Ireland, Scotland and Wales, they should also apply in Northern Ireland. However, the best way to achieve that is not having it dictated from Dublin or London but through the parties elected to represent the people of Northern Ireland coming together to form an administration. I hope they will do that.

While I firmly agree that rights are important, and Sinn Féin has put rights at the top of its list of priorities, there are other important matters as well. Brexit is one example. It is essential that there is a Northern Ireland voice on Brexit as we enter into the talks on the withdrawal agreement and the agreement that will set out the new relationship between the United Kingdom and the European Union. There are other practical, day-to-day issues that affect Northern Ireland. I have read about what is happening in the health service in Northern Ireland. The issues there are quite similar to the ones we are facing. Of course, the Sinn Féin leader in the North, Michelle O'Neill, was the health Minister in Northern Ireland up until a few months ago. I also read about the problems in the public finances in Northern Ireland, which are very different from the ones here, and the big and difficult decisions that will have to be made by the parties forming the executive to put the public finances back in order. A Sinn Féin person was in charge of those finances up until a few weeks ago.

Yes, I absolutely agree with the Deputy on rights, but taking responsibility is also important. We should never use demands for rights as a means to allow us not to take responsibility as well.

None of us should underestimate the difficulties facing unionist leaders. Many of them are fundamentally opposed to a rights-based society, but rights and equality for everyone are good for everyone. As the Taoiseach said, Brexit will continue to cast a long shadow over Irish affairs for some time to come.

That has to be resisted and the rights of the people of the North upheld. It is self-evident that locally elected and accountable politicians are best placed to tackle this and the other social and economic issues and to defend public services such as health and housing. Those of us who want Irish unity also know that is the best way forward.

I again appeal to the Taoiseach to support this approach, as he is obliged to do under the Good Friday Agreement and other agreements, and to ensure, in so far as he can, that the British Government and Prime Minister do likewise. I appeal to him not to allow party politics to interfere with this issue.

I will strongly support the new talks process that has been initiated by the Tánaiste and Minister for Foreign Affairs and Trade, Deputy Coveney, who will be in Belfast tomorrow, and the Secretary of State for Northern Ireland, Karen Bradley. I hope to have a chance to talk to Prime Minister May this week. The Government I lead is cognisant of its role as co-guarantor of the Good Friday Agreement and its special role in vindicating the rights and wishes of Irish citizens in Northern Ireland. I will be taking an interest in this on an ongoing basis and will become personally involved if we believe it can make a difference at a certain point.

I too recognise and welcome our distinguished visitors to the House.

The Government yesterday repackaged and rebranded three announcements on housing. Rents are now at an all-time high in Dublin, 14% above the previous 2007 peak. The pilot affordable rental scheme will be of little benefit to those facing record rents and new leases. The Government plans to reduce costs, build smaller apartments, reintroduce bedsits and have people use shared kitchens and other facilities. We still do not know how many new homes were built last year but it is believed that fewer than 10,000 new homes were completed in that period although between 25,000 and 35,000 were needed. The private market has failed to deliver.

The affordable purchase scheme is light on specifics but the hope is that it will deliver between 3,000 and 10,000 homes. It would provide developers with access to State-owned property and the State would fund the servicing of State-owned lands.

The newly rebranded council loan scheme has also been announced. The amount that people can borrow under the scheme has been reduced from 97% to 90% of the cost of a house. Those who might apply, many of whom have already visited my constituency office, are already paying record rents and will now have to face additional costs in terms of a deposit. For example, a person would have to save a deposit of €20,000 to purchase a €200,000 house. The help-to-buy scheme may provide some assistance in that regard and fixing interest rates would be of benefit over the lifetime of a loan but the numbers benefitting will be small.

The Minister for Housing, Planning and Local Government, Deputy Eoghan Murphy, yesterday said there is no need for a new agency with money, power, resources and control of land to build and deliver affordable housing. The State intends to change building regulations to make apartments more profitable, to provide the land for affordable housing, to pay for infrastructure through the housing activation fund, to finance developers - as announced at the time of the budget - through Home Building Finance Ireland, to help people to put together a deposit through the help-to-buy scheme and now intends to finance loans to home buyers through the Rebuilding Ireland home loan scheme. In that case, why do we not establish a new housing agency to deliver affordable housing and use the 700 publicly owned sites we have and the monetary resources the Government has allocated - more could be available through NAMA - to work with the local authorities and voluntary housing agencies to build and deliver these houses?

The Government's objectives on housing are threefold. First, it aims to reduce the number of people who are homeless. I am encouraged by the reduction in the number of rough sleepers over the Christmas period and into January and the fall in the number of families in emergency accommodation in January as a consequence of Government actions. However, one fall is not a trend, so I do not want to make too much of that although it is encouraging that those two things have been recorded and recognised.

The second objective is to provide more social housing in order to reduce the housing list. I am encouraged that the number of houses being built by local authorities and approved housing bodies is increasing, from fewer than 700 in 2016 to more than 2,000 in 2017. It will be closer to 4,000 this year. If we could ramp things up quicker we would, but it takes time to ramp up construction in the public and the private sector given the lost decade we have had.

One of our very important objectives is to recognise the fact that the vast majority of people provide their own housing. They save, get a mortgage and buy their house. This is what they want. They want to be able to buy and own their own home. We have to assist people to do that. This involves a number of things such as putting in place actions that will help the private sector and builders to start building again. We do not have a perfect measure of the number of houses that are built in the State in any given year but it appears to have been between 15,000 and 20,000 last year. This also shows an increase in construction. The fact is that we can see this construction all around us, be it cranes or housing estates in our constituencies. We anticipate new home construction rising to between 20,000 and 25,000 this year, getting to the point where things stop getting worse, as it were, and perhaps getting better again the year after.

As well as building houses, people need to be able to get mortgages and this is why the Minister, Deputy Eoghan Murphy, brought the proposals forward yesterday. It is for people who have not been able to get a mortgage from the bank so they can go to their local authority and secure a low-interest loan with a guaranteed interest rate for 30 years, which I believe is a positive offer. I am aware there were a huge number of calls being made to the authorities about the Rebuilding Ireland loan and extra staff have been taken on because of the number of people contacting the helpline and accessing the Rebuilding Ireland loan website.

With regard to the setting up of new agencies, I believe that the establishment of a new agency is often the default solution to every problem in Ireland. It does not always work. It is not something we would rule out but we must be realistic about it. It takes nearly 12 months to set up a new government agency and that is what one spends one's time doing during that period, not building houses. This new agency would presumably still have to contract out to the private sector. Unless it is taking on builders, carpenters, plumbers and so on, an agency such as that would have to contract and do procurement so even after a 12 month set up period, it would only then be starting on the process of issuing tenders.

I would also be very cautious of doing anything that takes the pressure off local authorities. We are putting councils and local authorities under enormous pressure to start building again. Some of them are doing better than others and it concerns me when I hear the Opposition suggesting that in some way responsibility might be taken away from the local authorities and handed over to an agency. Some councils or local authorities would not mind getting out of this entirely and if they thought that another party was going to come along and relieve them of this burden and obligation, it would not be helpful.

Housing is an essential element of any civilised society. The notion that the Taoiseach would be so complacent as to think it is all right and it is all working is amazing. I thought we had all agreed that not enough homes were being built for affordable sale or rent in the State. People at whom the new council loan scheme is aimed will have to find somewhere between €15,000 and €30,000 as a deposit. How are the very people who are being refused mortgages by banks and building societies supposed to pay exorbitant rent and at the same time save €20,000 or €25,000 as a deposit? That is a hopeless task to put to them. Effectively, the Government is now financing every side of the private housing market. From every angle, the Government has found a support base for the private housing market. What I ask for is very simple - the creation of a national State agency to use the resources of the State, the land of the State and the commitment of the State to build affordable housing for our people in a crisis.

The Taoiseach will conclude on this matter.

I did not actually make any of the contentions that Deputy Howlin has accused me of, so I will not reply to them one by one. It is often the case that people are refused a mortgage because they cannot pay the interest rate. Consider the difference between a mortgage where the interest rate is 3.5% and a mortgage with an interest rate of 2% which is guaranteed and locked in for 30 years.

One's ability to afford a mortgage is based on the monthly repayment and the repayments under this mortgage will be considerably lower than is the case for mortgages given by the banks.

If the person can save €20,000.

We will be able to assess this in the next couple of weeks and months and will see how many people apply for and get these new loans. I predict this might be one of the ones where we will be coming back in a few months' time to expand it and will be offering these low-cost loans with fixed interest rates to more people.

It should have happened years ago.

It has always been the case that a person needs to raise a deposit to buy a house. People do it in many different ways. Sometimes people go abroad for a period and earn money. Others get money from their parents. Lots of us did. Others get money through other loans. Sometimes people stay at home for a period and raise a deposit in that way. It has always been the case that a person had to be able to raise a deposit to buy his or her own home, with the exception of one period during the boom when we had 100% loans. I would not like us to get back to 100% loans because we know where that led us.

This is directed at the Taoiseach and the Minister for Rural and Community Development, Deputy Ring, in particular. They will be aware that no funding was available for local improvement scheme roads from 2011 to 2016. I always would be of the contention that the most important stretch of road in the country for a person living in a rural area is the stretch from his or her own house to the next main road because, even if it is a private road, wherever a person is going he or she will have to travel that road anyway. For those five years, no funding was made available to the local authorities. During the 70 or 72 days of the discussions for the programme for Government, I raised this issue continuously, as did others, because it was so important to have it included in the programme. I welcome that the Government kept its commitment - there is no better person to fight for and secure funding at budget meetings for these roads than the Minister, Deputy Ring - and I welcome the funding that was allocated, which was approximately €10 million. In my county, it made an awful difference and was most welcome.

Today, I seek two things. The first is to ensure there is an increase in the funding because it is money extremely well spent. It goes back into our local economies. It is evenly divided among local authorities and has a local impact on rural areas as, given there is nothing worse than travelling a bad road, it improves people's quality of life. If a person and all his or her family members have to travel a bad road every day, or perhaps five, ten or 15 times a day, it means much to have the road improved. One could not get over how much it means. The money strengthens local areas as it is extra work for local authority workers. It is money for those supplying the materials and the work that needs to be carried out. It is a win-win every way.

I am, therefore, seeking an increase in the funding this year and that the Minister, Deputy Ring, would be allowed to secure at least €15 million rather than €10 million. Second, historically, it has been late August, September or into October when the funding has been announced. This is extremely difficult for and unfair to local authorities because they are then under pressure to spend the money when the weather is bad. There is a rush and this puts pressure on them. I would appreciate a response from the Taoiseach on those two issues.

I am really pleased that the Government was able to restore the local improvement scheme last year. I included it in my manifesto when I ran for leadership of my party. It is also in the programme for Government, which the Deputy was involved in negotiating, and is something that is very much welcomed in rural parts of Ireland.

While these roads and laneways are not public roads, they are very often the part that accesses a number of houses, farms, businesses and so on and people who live in those houses and own those farms and businesses are people who pay tax too. Even though the road may not be officially taken in charge, people living in rural Ireland pay their motor tax, pay excise on petrol and diesel, pay VRT and now pay the local property tax. It is only right that we set aside some money for the local improvement scheme and we do so every year.

The Deputy asked two questions. The budget is €10 million this year but it is too early to add to the budget now. We can review it later if there is spare finance, either in the Department of Rural and Community Development or the Department of Transport, Tourism and Sport, but it is too soon at the moment to reallocate money between Departments. On timing, I can give the Deputy a favourable answer. Last year, the decision to reintroduce the local improvement scheme was only made in the summer, so we were not able to make the allocation until the latter part of the year, but it is the Minister's intention to bring it forward this year and to make the allocations in the first half of this year, if not in the first quarter, which will allow local authorities to make decisions sooner and will allow the work to be done in better weather, when it is drier over summer and autumn. This will be welcomed across rural Ireland.

The Minister, Deputy Ring, knows better than anyone that agreeing to announce the level of funding in the year will make an awful difference to our local authorities. I cannot let the opportunity go without praising our own local authority, Kerry County Council, the management engineers, its area engineers and its senior executive engineers, who work diligently. I praise every one of the contractors too. They play a vital role because, unlike a lot of people in this House, they create a lot of employment. Some politicians in here never created one job for anybody so we have to compliment contractors who create work in their local communities. It is fortunate they are there.

The early announcement of the money will help the excellent staff in local authorities, not just in Kerry County Council which is, obviously, the best local authority in the country. They will appreciate it and they will be grateful for the Taoiseach's announcement. It is what I call sensible work by Government. Every €1 million more than the €10 million announced last year, however, would make an awful difference and would be most welcome. Kerry will accommodate many millions more. We will spend it too.

We should not forget to compliment the Minister for Rural and Community Development, Deputy Ring, and the officials of his new Department who managed, at very short notice in the summer and autumn when they were only setting up the Department, to get the money out to local authorities. Deputy Healy-Rae will be glad to know that Kerry is among the top five for securing money under the scheme, the first being Donegal, followed by Galway, Mayo and Cork - all rural counties with lots of roads. Last year, Kerry County Council was allocated €995,000 under the scheme and managed to spend €980,000 of that, making it one of the most efficient local authorities in spending the money allocated to it. I believe there are some very efficient contractors in the county too, who are always able to get the job done.