Yesterday, we had taken the group of questions, Nos. 12 to 21, inclusive. Deputy Howlin was in possession.
Taoiseach's Meetings and Engagements: Supplementary Questions
I will briefly restate the questions I posed. I said that when I asked on 13 December 2017 where the Taoiseach was visiting, he did not tell me that he was going to Budapest and it is surprising that an important visit such as that was not scheduled a matter of weeks beforehand. The Taoiseach in his reply yesterday indicated that he laid out to Prime Minister Orbán concerns in respect of the policy being pursued by his government. What reply did he get? I also asked whether any NGOs in Hungary had asked to meet the Taoiseach on his visit and whether he met them.
The Taoiseach's speech to the European Parliament was surprising in the extent to which it failed to address most of the most urgent issues facing the EU. One of these is how we react to member states that seem to reject basic democratic norms such as the balance of power and independence for both the media and academia. Hungary is a member state and we must deal with it. I do not have an issue with the Taoiseach meeting the Hungarian Prime Minister but it is striking that he has so little to say on this core issue. What does he think the Union should do when a member state tries to put the judiciary under the direct control of government, attacks journalists and tries to undermine funding for NGOs? Like Deputy Howlin, I would like clarification on whether the Taoiseach made any attempt to meet civic society representatives in Hungary during this visit. This will become a bigger issue in the near future. The far right FPO in Austria will, if it is true to past form, start attacking important pillars of the Union. Last weekend, a journalist was physically attacked at a press conference held by the Czech President and the new Czech Prime Minister verbally attacked a journalist on the same day. Is it not reasonable to expect the Taoiseach to be clearer on this issue than he has been and to be so in Strasbourg, Brussels and elsewhere? He said he would raise the issue of the rule of law in Budapest. What exactly did he say and what was the response?
Concerning the meeting with the Bulgarian Prime Minister, will the Taoiseach be more specific about the proposals he put to him regarding Ireland's priorities within the Council of Ministers?
The European Council President, Donald Tusk, at the EU summit in December endeavoured to launch a major review of the Union's migration policy. It seems that there was much disagreement on this issue and that Hungary and other member states were opposed to mandatory relocation quotas. It was agreed to set up a fund to stem the flow of illegal migration and to consider further the reform of the Dublin Convention at the meeting to be held in June. Given its geographic location, Ireland is not at the coalface of this problem but I hope that our approach is based on the view that this is a humanitarian crisis that needs a humanitarian response.
There has been an increase in illiberal tendencies within the EU in recent years. Traditional liberal and democratic values are being challenged in Poland and Hungary, in particular. The EU has invoked Article 7 in respect of Poland in response to changes made to the appointment of judges there. Hungary is siding with Poland in opposing this move by Brussels. In addition, both countries are opposed to deepening EU integration. The Council will have to address this issue. Sanctions may be imposed on Poland and the flow of Structural Funds may be hit. Did the Taoiseach discuss this matter with Prime Minister Orbán? Did he also discuss the issue of tax harmonisation with him? I presume Ireland and Hungary have the same view on this. All of this can be viewed in the context of the future of Europe and the ongoing debate in this regard.
Viktor Orbán is part of a dangerous political cancer that is growing in Europe, which is characterised by extreme racism, authoritarianism and anti-democratic tendencies, which in some cases is directly linked to fascist organisations.
While it is reasonable to say we should talk to people even if we disagree with them which I know is the Taoiseach's standard line on these matters, there is a problem and a line in terms of what is acceptable. To take the obvious example, appeasement did not work with the fascist movement in the 1930s because it was not interested in democracy. It was interested in promoting a filthy, racist, anti-democratic, authoritarian version of politics. This week Viktor Orbán is meeting the Freedom Party of Austria which was set up by former Nazis. They are clubbing together as an extreme right-wing group which is promoting racism, flouting the UN Convention on Human Rights when it comes to the treatment of immigrants, suppressing press freedom and compromising the independence of the judiciary. At some point the Taoiseach has to recognise that when democracy, whatever stripe one supports, is under threat from people such as Viktor Orbán, we have to take a clear stand against those politics and begin to work out a strategy to defeat rather than conciliate it.
Prime Minister Orbán gave me and the Minister of State, Deputy Helen McEntee, quite a lot of time. There was an opportunity for the two of us to understand, parse and analyse his philosophy a little better. Essentially, he believes in four pillars: Christianity, the Hungarian nation, the family and competitiveness. Even though his party is part of the same political family as mine, it is fair to say we are at the opposite ends of the internal spectrum. We are more secular, globalist and internationalist and have a wider view of what family means, but we are very much aligned with Mr. Orbán's party on issues surrounding economics and competitiveness. As Deputy Seán Haughey pointed out, Hungary and Ireland share the same view on tax. In fact, it has a lower corporation tax rate than we do and will certainly be an ally of ours in opposing any attempt to remove tax sovereignty from member states. We have a similar view on Brexit and the western Balkans and share a view that the European budget should be well funded and continue to provide adequate structural funds in central and eastern Europe and adequate funds for the Common Agricultural Policy.
There are many issues on which we are aligned, but we were certainly able to discuss in detail issues on which we were not. There were no meetings held with anyone else in Hungary. I met the Prime Minister and then finished for the night and flew on to Bulgaria for further meetings. I did raise the issue of non-governmental organisations, NGOs. Mr. Orbán pointed out that the matter was before the European Court of Justice. Hungary believes it will win the case. One of the things it is pointing out - this may be of interest to Members of this House - is that Ireland has laws which ban NGOs from receiving foreign money for referenda and campaigns. I do not believe it is quite the same thing, but it is interesting that it is part of Hungary's defence. By the way, I did tell Mr. Orbán that I did not think it was the same thing. On university laws, Mr. Orbán pointed out that all of the other foreign universities had accepted the new laws. On the judiciary and the media, he pointed out that those cases were closed as far as the European Commission was concerned. The Commission is satisfied that Hungary has complied and responded to European concerns about judicial and media freedom. I anticipate that Poland will also respond to European concerns, thereby avoiding a situation where we would have to impose sanctions on it. We profoundly disagreed on the issue of migration. We are accepting quotas of refugees, Hungary is not. While we profoundly disagreed on the issue, we did agree that the Dublin Convention system was not working.
To pick up on Deputy Richard Boyd Barrett's comments, he is right. I do believe in engagement and I am not going to depart from that belief. However, I am also not naive in respect of the move away from liberal democracy which is under way in central and eastern Europe. It is something about which I am very concerned. However, I ask the Deputy to avoid double standards. I have heard people from his political movement, if not him, laud the Bolívarian revolution that happened in Venezuela some years ago. We all see what is happening there now. Democracy is being totally undermined and the country is in slow collapse as can be seen in the rise in the incidence of infant mortality.
I am deeply critical of it.
What happened in Venezuela was not that socialism was not implemented properly but that it was implemented to the letter.
No; it was not.
Taoiseach's Meetings and Engagements
11. Deputy Micheál Martin asked the Taoiseach if he has had discussions recently with Prime Minister May regarding Northern Ireland and phase two of the Brexit talks. [1387/18]
12. Deputy Eamon Ryan asked the Taoiseach if he has spoken with Prime Minister Theresa May since the recent cabinet reshuffle in the United Kingdom and the appointment of a new Secretary of State for Northern Ireland. [1790/18]
13. Deputy Gerry Adams asked the Taoiseach if he will report on his meeting with the British Prime Minister, Ms Theresa May on 14 December 2017. [1828/18]
14. Deputy Micheál Martin asked the Taoiseach if he has spoken to Prime Minister May since his appointment regarding outstanding issues under the Good Friday Agreement, in particular in relation to inquiries into the Dublin and Monaghan bombings and the Kingsmill massacre. [2113/18]
15. Deputy Micheál Martin asked the Taoiseach if he has spoken to Prime Minister May in January 2018 regarding Northern Ireland and Brexit. [3061/18]
16. Deputy Brendan Howlin asked the Taoiseach if he will report on his meeting with the UK Prime Minister in December 2017; and if he has had discussions recently with Prime Minister May regarding Northern Ireland and phase two of the Brexit talks. [3379/18]
17. Deputy Eamon Ryan asked the Taoiseach if he has had discussions recently with Prime Minister May regarding phase two of the Brexit talks. [3449/18]
18. Deputy Micheál Martin asked the Taoiseach if he has spoken to Prime Minister May since talks to reconvene the Northern Ireland Executive have recommenced. [4322/18]
I propose to take Questions Nos. 11 to 18, inclusive, together.
I last spoke to Prime Minister May on Thursday, 7 December, as I reported to the House on 12 December. I had no scheduled bilateral meeting with the Prime Minister around the European Council meeting on 14 December, although I did see her and we discussed a number of issues, both on a one-to-one basis and as part of group meetings.
In December the European Council formally took the decision that sufficient progress had been made in phase one of the Brexit negotiations, enabling the process to advance to phase two, during which transition arrangements and the framework for the United Kingdom's future relationship with the European Union would be considered. There is still a lot of work to do and close attention will be paid to ensure all of the commitments and principles agreed in the joint EU-UK report on citizens' rights, the financial settlement and the issues specific to Ireland are given full legal effect in the withdrawal agreement. I have been very clear with the UK Government that we expect it to fully honour the commitments entered into in December. This will be a focus in the coming weeks and months. I am pleased that the European Council also agreed to negotiate a transition period and prioritise discussion of it in the first part of phase two.
There is regular ongoing contact between my Department and the British Government at official level on Brexit and the situation in Northern Ireland. Prime Minister May and I exchanged messages on the day of her recent Cabinet reshuffle. There has also been extensive contact between the Tánaiste and the new Secretary of State for Northern Ireland, Karen Bradley. The Tánaiste met the Secretary of State in London soon after her appointment and again in Belfast on Thursday, 18 January, where they discussed the political situation in Northern Ireland. The Tánaiste was in Stormont on Monday and will be engaged in it again later in the week. I am very pleased that political talks to restore the Executive have restarted and I am in regular contact with the Tánaiste on these developments. I spoke to him as recently as yesterday.
As co-guarantors of the Good Friday Agreement, the British and Irish Governments have a responsibility to ensure the effective functioning of its institutions. The two Governments will work in partnership in seeking a return to devolved power-sharing in Northern Ireland, which is at the heart of the Good Friday Agreement. I believe it remains possible to reach an agreed outcome which will ensure implementation of previous agreements and reflect the core principles of the Good Friday Agreement and power-sharing - partnership, equality and mutual respect. The Government has consistently affirmed its unwavering commitment to the agreement and determination as a co-guarantor to secure the effective operation of all institutions.
In my discussions with Prime Minister May I have stressed the importance of making progress on legacy issues and the overall arrangements for dealing with the past. While the Kingsmill massacre has not arisen specifically in our discussions, I have raised the Dublin and Monaghan Bombings and other legacy cases with the Prime Minister. The Government is strongly committed to and working to achieve the establishment of the legacy institutions provided for in the Stormont House Agreement as soon as possible. The Government will continue to engage with the British Government on the Dublin and Monaghan bombings and will pursue all possible avenues that could achieve progress on the issue, consistent with the request made by the Dáil, in the hope it could bring some measure of closure to the bereaved families.
One of the clearest messages of the last month is that nothing has actually been secured for Ireland in the negotiations thus far. When the spin and self-congratulation are put aside, the reality is that the phase one agreement commits the United Kingdom and the European Union to the same positions they offered at the start of the process. The frustration is that, so far, there has not been a single credible proposal from either the Government or the government of the United Kingdom on how the special circumstances associated with the Border will be dealt with. The United Kingdom's position is that there will be a soft border but that the United Kingdom will be outside both the customs union and the Single Market. The Taoiseach's position is that we would like it to stay, but so far there has been no word of any approach that could reconcile these positions, particularly since the two Governments seem to be opposed to a deal specific to Northern Ireland. Will the Taoiseach tell us when specific proposals are likely to be made?
The Taoiseach will also know that the UK Government has produced an impact assessment, albeit one that the hardliners are now denouncing as a sinister plot because it contains some unpleasant truths regarding the British economy. Months ago, the Taoiseach promised in this Chamber that impact studies for Ireland would be published. Will they be published and where are they now? How is it possible for policy to be developed without in-depth sectoral information on the impact of Brexit and the options for Irish business?
Regarding Northern Ireland, the detachment of both Governments over the past seven years has been a factor in the breakdown of the institutions, the general decline of North-South bodies, the lack of North-South impetus under the Good Friday Agreement and the general decline in the Executive and Assembly. I have stated repeatedly that it is inexcusable that the Executive and institutions have not been restored. I hold both of the main parties responsible for that. My genuine view is that it was a contrived collapsed. Given the threat of Brexit, however, it is essential that the Assembly and Executive be restored so that the anti-Brexit voice in Northern Ireland can have a forum to articulate its concerns and views and the institutions can be used professionally and properly as a conduit for reconciling conflicting positions in the best interests of the economic well-being of all the people on this island.
Negotiations involving the two Governments and the parties in the North have recommenced. Sinn Féin has met representatives of those sectors whose rights are being denied and the current negotiations are trying to vindicate. Sinn Féin is committed to the full restoration of the political institutions. It makes sense that local politicians take the local decisions that affect citizens. To achieve this, however, the issues that led to the collapse of the institutions need to be dealt with effectively. The new round of negotiations continues to be about the implementation of past agreements, specifically on ensuring that citizens in the North can enjoy the same rights that everyone in the Dáil has.
Regarding the statement that the collapse of the Assembly was contrived, it happened because of the controversy surrounding the renewable heat incentive, RHI, scandal. Sinn Féin would not stand for that. On the other hand, Fianna Fáil has been involved in many scandals. Maybe that is why it is taking this stand.
Sinn Féin's negotiating team is working hard to reduce the political tension between unionism and nationalism. If progress is to be made, it must be on the basis of respect and equality. It must be about implementing previous agreements. The DUP knows this, as do both Governments. Will the Taoiseach reaffirm his commitment that, in the event of there being no agreement, he will seek the establishment of the Intergovernmental Conference?
Is the Taoiseach aware of the great concern in the North about the new constituency boundary proposals that have been published by the Boundary Commission for Northern Ireland? They mark a significant shift away from the 2016 proposals and are believed by many to have resulted from pressure from the DUP on the British Government. Consequently, there will be four constituencies with no nationalist representation in the future Assembly. This is in stark contrast to the fact that there will be unionist representation in every single constituency. The Taoiseach is aware that gerrymandering was extensively used to minimise nationalist representation and maximise unionist representation. Will the Irish Government undertake a thorough analysis of the boundary proposals and raise this matter with the British Government at the most senior level?
Talks on restoring the Northern Ireland Executive broke down last autumn and have recently resumed. We wish them well. It is my understanding that when the talks ended last October, the parties were close to an agreement and the DUP and Sinn Féin in particular had moved their negotiating positions substantially. There have been calls from the leader of the SDLP for the details of the reported compromise to be put into the public domain and for all the surrounding papers to be made available for public purview so that we can know how close the two parties were to a deal. Will the Irish Government publish the papers and call on the other main actors to do this so that the Irish people, North and South, can see how close a deal was at that time?
During the Taoiseach's discussions with Prime Minister May, did he refer to the polarisation that would ensue from another round of elections or direct rule and what was her specific response?
A point was made about the Brexit talks. The irreconcilable position that was agreed last year, which we welcomed, was almost like what used to happen in the North, in that we would have constructive and deliberate ambiguity so that people could work out the detail subsequently. The problem is that all the utterances since then - I have listened to Mr. David Davis, Mr. Jacob Rees-Mogg and Ms Theresa Villiers - have made it crystal clear from a British Tory perspective that Northern Ireland will remain in the UK customs union and the UK as a whole, including Northern Ireland, will not be a part of any European customs union. How are we to break that deadlock? Are we just to pretend that it is a reconcilable position until it actually becomes manifest when the endgame is reached and the UK leaves the EU in March of next year?
What was secured back in December is there in black and white for anyone to see and anyone to read. It is there in the joint report, which was agreed between the European Union and the United Kingdom. It contains specific "commitments" - that is the term used - from the UK Government in respect of the avoidance of a hard border. It is now our objective to ensure that those commitments are written into the withdrawal agreement, which is currently under negotiation, so that they become legally binding. That is what we are working on at the moment.
There is a political border between Northern Ireland and Ireland, they are different jurisdictions and different currencies are used, but when it comes to avoiding a hard border, which in my mind is any new barrier to the free movement of people or any new barrier to free trade, that can be done in one of two ways. One is under the auspices or umbrella of a new UK-EU relationship, which could include a customs union partnership between the European Union and the United Kingdom. I use the term "customs union partnership" because that is the term used in the UK Government's own documents. Neither Jacob Rees-Mogg nor Theresa Villiers are members of the British Government, although they are, of course, MPs and free to give their opinions on these issues.
If that cannot be achieved through a customs union partnership or through the new UK-EU agreement, there is an option to have a unique solution for Northern Ireland. That is certainly not something that our Government is opposed to. In fact, that is what paragraph No. 49 talks about in the December joint report. However, it is our preference that we deal with this issue as part of the new UK-EU relationship because I do not want to see any new barrier between Britain and Ireland anymore than I want to see any barrier between Newry and Dundalk. I do not want to see those barriers between Dublin and Holyhead either. If we are interested in Irish industry and Irish jobs, in particular tourism and agriculture, we should be trying to achieve an outcome that allows us to continue to have free movement and free trade between Britain and Ireland, not just between Northern Ireland and Ireland. Anyone who is involved in exporting, tourism or agriculture or whose job is dependent on any of those things will understand why we are pursuing that as a strategy. A unique solution for Northern Ireland is very much secondary to the solution to that which we hope to achieve.
There are talks ongoing in Belfast at the moment. They are at a sensitive stage. I want them to succeed. I think this is the last chance for them to succeed. I am very concerned that, if they do not succeed on this occasion, we will not see the restoration of the institutions for many years. That is why I do not want to say too much - I would not wish to upset anyone or give anyone any reason to get upset.
Perhaps I will not say as much as I would like to say on this occasion. If the talks fail, I can confirm that the Government will seek the implementation of the Good Friday Agreement in full in the absence of those institutions.
Several Brexit impact analyses have already been published. Building Stronger Business: Responding to Brexit by Competing, Innovating and Trading was published by the Department of Business, Enterprise and Innovation. There is an ESRI paper on Ireland's international trade and transport connections. The UK EU Exit: Trade Exposures of Sectors in the Irish Economy in a European Context is a document from the Department of Finance. Ireland and the Negotiations on the UK Withdrawal from the European Union: The Government's Approach is a whole-of-government document. An all-island civic dialogue compendium and report of the second plenary has been published.
Bord Bia has also produced an industry findings report on the impact on that sector. The Department of Transport, Tourism and Sport produced Transport Trends, an overview of the transport sector dealing with the impact on transport connections. InterTradeIreland has produced a document on the potential impact of WTO tariffs on cross-Border trade should there be a hard Brexit. There is also the Brexit Maritime Transport Workshop Report from the Department of Transport, Tourism and Sport. Tourism Ireland produced a sectoral analysis on the potential impacts of Brexit on tourism to the island of Ireland in 2017 and beyond. The Department of Finance published the UK EU exit and exposure analysis of sectors in the Irish economy, focusing in particular on the potential impact on the financial services sector. It also produced a document, Brexit Trade Exposures of Sectors of the Irish Economy in a European Context.
The ESRI produced a product and sectoral level impact assessment of hard Brexit across the EU. In partnership with the Department of Finance, it produced a document entitled Modelling the Medium to Long Term Potential Macroeconomic Impact of Brexit in Ireland, which deals with how it might affect our debt and public finances. There is also Getting Ireland Brexit Ready from the Department of Finance and the Irish Government's contingency summary. There have been a number of impact analyses produced already by Government bodies and there will be more in the future. Unfortunately, they are largely speculative because we do not yet know what Brexit will look like.
Cabinet Committee Meetings
Richard Boyd BarrettQuestion:
19. Deputy Richard Boyd Barrett asked the Taoiseach when Cabinet committee E (health) will next meet. [1681/18]
20. Deputy Gerry Adams asked the Taoiseach when Cabinet committee E (health) last met; and when it is scheduled to meet again. [3050/18]
21. Deputy Brendan Howlin asked the Taoiseach when Cabinet committee E (health) last met; and when it will next meet. [4551/18]
I propose to take Questions Nos. 19 to 21, inclusive, together.
Cabinet committee E covers issues relating to the health service, including health system reforms. The committee last met on 23 November and will meet again on 15 February. In addition to meetings of the full Cabinet and Cabinet committees, I meet Ministers individually, as required, on particular issues. In this regard, I regularly meet the Minister for Health, Deputy Harris, to discuss the challenges facing the health service, and did so as recently as last week. While there will be a need for increased investment in the health service over the years to come, reform and productivity gains must happen in tandem or we will provide no benefits for patients and only costs for the taxpayer.
The Government has affirmed its commitment to implementing a significant programme of reform following the publication of the Sláintecare report by the Committee on the Future of Healthcare last year. Work on the report is linked to the health service capacity review which has been published, the new GP and primary care strategy and the work of the independent review group which is examining the removal of private practice from public hospitals, a specific recommendation of the Sláintecare report. A group under Donal de Buitléir has been established to do exactly that. Work will be taken forward under the auspices of the committee.
Over the past week the Taoiseach has repeatedly refused to answer direct questions on the health budget. Yesterday he tried to deflect by saying that all agencies look for more and the HSE is no different. This is not the point. The issue is the Government insisting on promising a level of services which it knows cannot be delivered for the amount of money allocated in the budget. That is the core point.
Massive overruns are not always inevitable. Over recent years the overruns have been result of a Government policy which agreed a budget and promised a higher level of service than could be delivered by that budget. That has undermined proper planning and led to escalating overruns. We know that two or three years ago we were essentially given budgets. In response, in a practice patented by the Taoiseach, the Government wrings its hands and says it is all the fault of the administrators. Information discovered by journalists through freedom of information requests, which was not made available by the Government, clearly states that the health budget is a sham. It is based on levels of savings which have no justification and service levels higher than can be delivered.
When did the Taoiseach become aware that the savings figure in the health budget were an invention with no basis in fact? That is not my presentation. It is from the HSE itself. Will he assure the House that we are being provided with all relevant information to help us assess the credibility of the health budget? This is a simple matter. I ask the Taoiseach to answer the questions.
In respect of section 39 organisations, earlier today the Taoiseach used language which suggested that the workers were caught in the middle and that there was a differential opening up. The workers in section 39 organisations are not caught in the middle. They are suffering because the Government decided not to fund their pay restoration. The Government funded pay restoration for HSE employees, but those working in disability services, hospitals and mental health services throughout the country were deliberately excluded by the Government because of a lack of transparency and honesty around the budget. I want a straight answer. The HSE said it will not be able to make the savings identified in the budget. When did the Taoiseach become aware of that?
The Euro Health Consumer Index for 2017 published this week rates waiting times for health care in the State as among the worst in Europe. We are in 24th place, which is even lower than the previous year. The authors, understandably, ask why countries with more limited means can achieve a virtual absence of waiting lists while this State fails to do so. Why can we not address this? This week has also seen record levels of patients lying on hospital trolleys. Today, 415 are languishing on hospital trolleys throughout the State. Yesterday, the figure was 644. On Monday, the figure was 543.
The publication of the report of the bed capacity review last week confirmed that, without investment and reform, this appalling situation is set to continue. There is little in the report that patients, politicians and health service workers do not know already. The report confirms that emergency department attendances will increase significantly. It also identifies a necessary increase of at least 2,600 beds in public hospitals, a projected increase of 190 adult critical care beds and 13,000 for older citizens in residential settings.
All of these beds require a planned and funded recruitment and retention strategy for nurses. The recommendations on staffing and the recruitment of nurses, doctors and other health care staff need to be addressed as a matter of urgency. This cannot be done unless the recruitment and retention crisis across all grades in the health service is addressed. That means addressing in a meaningful way working conditions, facilities, supports, training, promotion opportunities and pay.
Does the Taoiseach accept that this requires the Government to engage meaningfully with workers, representative bodies and unions, as well as establishing a commission on pay in the health service for medical professionals and health care workers, as recommended by the Dáil? What steps will the Government take to fit these recommendations into the framework on the Sláintecare report?
The Taoiseach will be well aware of the commitment made to review cardiac services in the south east. There was grave concern and disquiet right across the region, in particular in Waterford as well as in neighbouring counties, including Wexford, Carlow, Kilkenny and Tipperary which were dependent on Waterford hospital for cardiac care. The south east did not have access on a 24-7 basis to cardiac treatment in a timely fashion, a situation which is unique. There was to be a review of Herrity and an examination of the parameters in respect of that. That has been enveloped by a new national cardiac services review.
Needless to say, because the timeline is 18 months, it has caused additional disquiet in the south east generally. In the interim, will the Government implement those elements of the Herity report it accepted on lengthening the operational hours of the existing catheterisation laboratory in Waterford city on weekdays and to include weekends? Will it ensure the first phase of the national review will involve the south east in order that we can determine the practical steps which can be made to ensure cardiac care services in the south east will measure up to those in the rest of the country?
I will do my best to answer as many direct questions as I can, but it is not always possible to answer questions directly when one does not have the answers or information in front of one or one's mind. We have this cycle most years in respect of the health service budget. The levels of activity are set out in the Health Service Executive, HSE, service plan for the numbers of outpatient attendances to be funded, the numbers of operations that will be performed, the numbers of emergency department attendances, the numbers of home care and respite care hours that will be provided and the numbers of medical cards that will be issued. Every year the Opposition states these levels of service will not be met.
I am not saying that.
Every year they are met or exceeded.
That is not the charge.
I do not accept the contention that the things set out in the HSE service plan will not be delivered. I think they will be because pretty much every year the level of activity has increased. At the same time, there is almost always a financial challenge during the year which we must work out and almost always it requires a Supplementary Estimate. It is hard to do it because the financial systems are so archaic and badly managed that it is March or April before we know how much the HSE spent in the previous year. That is atypical for public bodies. This goes on throughout the year and it would not be unusual to find a dramatic change in the estimated position from week to week; €100 million or €200 million can disappear or reappear in the space of a few weeks. That presents a real problem in planning. Last year there was a projected overrun in the primary care reimbursement service, PCRS, but it never materialised. However, another overrun by several hundred million euro appeared somewhere else. I would love the funding of the health service to be transparent and to know exactly where the money goes. We used to talk about money following the patient. I would like to be able to follow the money, but, unfortunately, we cannot do so. That is a big problem, one for which the Government takes responsibility.
The Public Service Pay Commission is examining the issue of pay for health care workers. It has been asked to examine the position for health care and Defence Forces staff first. In the meantime, public service pay restoration is well under way. Recruitment in the health service is now much easier than it was a year or two ago, which is encouraging. That is due, in part, to pay increasing again, but ironically it is also as a consequence of Brexit. Fewer overseas and EU workers are moving to the United Kingdom; they seem to be more willing to come here.
The European Health Consumer Index gives a mixed picture. It is poor on access. There is no point denying this, notwithstanding the fact that the numbers waiting for operations and procedures are falling, but they are not falling for outpatients. The index does point to good outcomes in some areas, which should be recognised. It gives us a green score based on the fact that Irish patients have access to novel drugs, as well as the cost of medicines. The Deputy will be aware that in Northern Ireland patients with cystic fibrosis do not have access to medicines such as Orkambi, but here patients do.
We had to drag the Government kicking and screaming to do it.
I hope that when Michelle O'Neill is back behind her desk, that matter will be sorted out. The index ranked us very highly on matters such as smoking prevention, blood pressure, vaccinations, cancer survival rates and potential years of life lost. It is a mixed picture, but it is not surprising. It is poor on access but reasonably good on patient outcomes and experiences.
I discussed the situation in the south east with the Minister for Health earlier this week. He plans to engage in a wide review, different from the one carried out under Professor Herity, one that will hear the voice of the patient and involve groups such as the Irish Heart Foundation. That follows a motion agreed to by the House a couple of months ago. I understand the funding has been put in place to extend the operating hours, but I do not know if it has yet happened. It does require having staff who are willing to work unsocial hours, which can sometimes be difficult.
Will the Taoiseach indicate a date when it might start?
No; I cannot.
It is important to distinguish between cardiology services and 24-hour primary percutaneous coronary intervention, PCI. They are not quite the same. Primary PCI for 24 hours is a highly specialised service that can be provided only in a relatively small number of regional centres. In the entirety of Scotland which has a population of 5 million people it might be provided in only two or three centres.
It has a very concentrated population of 5 million.
It is a question of ensuring quality because if the operators are not doing enough cases, the standard falls and the outcomes are worse.