Ceisteanna (Atógáil) - Questions (Resumed)

Cabinet Committee Meetings

Michael Moynihan


1. Deputy Michael Moynihan asked the Taoiseach the number of times Cabinet committee E, health, has met in 2019; and when it last met. [25595/19]

Joan Burton


2. Deputy Joan Burton asked the Taoiseach when Cabinet committee E, health, last met; and when it will next meet. [26568/19]

Richard Boyd Barrett


3. Deputy Richard Boyd Barrett asked the Taoiseach when Cabinet committee E, health, last met. [26623/19]

Brendan Howlin


4. Deputy Brendan Howlin asked the Taoiseach when Cabinet committee E, health, last met; and when it is next scheduled to meet. [26685/19]

I propose to take Questions Nos. 1 to 4, inclusive, together.

Cabinet committee E last met on 22 November 2018. A date for the next meeting is being scheduled for later this month. In addition to the meetings of the full Cabinet and of Cabinet committees, I often meet Ministers on an individual basis to focus on particular issues. In this regard, I meet regularly the Minister, Deputy Harris, and his officials and advisers to discuss issues relating to the health service, and health is discussed by the full Cabinet almost every week.

This year will see the highest ever level of health funding in the history of the State in order to transform the health service to one that can meet the changing needs of the population and be resilient to challenges presented by changing demographics.

We have also committed close to €11 billion in capital investment over the next ten years in the national development plan, Project Ireland 2040, to provide the infrastructure required for expanded community and acute care.

While there is a need for increased investment in the health service, reform and productivity gains must happen as well. These gains are not always easily realised and require a long-term strategic approach.

The Government is advancing a significant programme of reform to ensure meaningful and sustained improvement in the health service in the future.

The publication of the Sláintecare action plan for 2019, the first of what will be annual plans, sets out in a detailed and quantifiable way how the ambitious ten-year reform programme will be advanced this year. The first quarter progress report for this year is completed and all 28 deliverables are on track.

The guiding principle of Sláintecare is to provide the right care, in the right place, at the right time. Recent advancements include the following measures. Reduced prescription charges, reduced drug payment scheme thresholds and increased GP visit card income thresholds all came into effect in April. This is a step forward in benefitting hundreds of thousands of people by reducing the cost of healthcare for them. On 11 June, Government approved the general scheme of a Bill to change how productive assets are treated under the nursing home support scheme or fair deal. This will positively affect families who have family farms and businesses but now require nursing home care. An agreement has been reached with the Irish Medical Organisation on a major package of GP contractual reforms which will provide a 40% in resources for general practice, benefitting patients and make general practice a more attractive career option for doctors. Last Friday, the new HSE board had its first formal meeting following the Minister for Health signing the commencement order for the HSE (Governance) Act 2019. The board had been meeting prior to this on an interim or administrative basis. The board will strengthen the management, governance and accountability of the HSE.

The Taoiseach will be aware that the Minister for Finance has explicitly ruled out the possibility of any Supplementary Estimate for the Department of Health later this year but, in contrast, when pressed by Deputy Donnelly on this matter, the Minister for Health refused to rule out seeking a Supplementary Estimate. The Taoiseach might be able to explain the contradiction between the two Ministers in that regard. The Taoiseach might be able to indicate what he believes the full year outcome will be in relation to the health Estimate. Does the Taoiseach also believe that there will be no question of a Supplementary Estimate being required? He might clarify that for me.

I note that up to 2012 the HSE demonstrated a strong ability to deliver within budget but that changed due to a new political approach to service plans introduced by the Cabinet. The Irish Fiscal Advisory Council has said that ministerial and governmental decisions in demanding services but not providing the funding at the start of the year have directly added to the end of year Supplementary Estimates - in other words, at the beginning of the budget year every year the Government knew full well that what was provided for in the service plan could not have been met by the Estimate that was provided and that there would inevitably be a Supplementary Estimate. That has been an issue for quite a number of years. Does the Taoiseach accept this, or is that another recommendation of the Irish Fiscal Advisory Council which the Taoiseach will ignore?

I put it to the Taoiseach that whereas he talked about Sláintecare and some of the issues around thresholds, etc., that are doable, at the essence of the health service at the operational level are fundamental difficulties with access to the health service as manifested in overcrowding in accident and emergency departments and excessive deaths as a result. Much of that is contributed to by the deficiencies in step-down facilities, nursing home beds, rehabilitation beds and facilities, and facilitating efficient discharge from acute hospitals. In my view, the demographic realities of health have not been provided for in recent times. As a people, we are living longer. That is a good development but the numbers of people who attend the services, particularly emergency departments, for example, those over 65 years of age, is quite significant. The issue around care of the elderly, be it home care packages or, as I said, the various facilities required once discharge takes place, have not been provided for in budgetary terms by the Government and have been fudged year after year. Does the Taoiseach accept that basic proposition that the Government has not met the challenges arising out of demographic changes in terms of the health service?

One of the many problems of the health service in Ireland - I do not know whether the Cabinet committee or the Cabinet has had an opportunity to discuss this - is the dysfunctional recruitment of doctors within it. We now have one of the lowest numbers of doctors per head of population in the EU. At the same time, we are increasingly relying on the recruitment of doctors trained outside of Ireland and coming to this country. Within a few short years, the service has become dependent on a category of junior doctors, most of them foreign trained and on the lower rungs of their medical careers. Ever more healthcare is delivered not by consultants or trainees who are in secure career structures, but by an ever-growing army of non-training scheme doctors. This is unfair to those in the medical profession who want to work as doctors and who have a completely uncertain career path, so much so that many of the foreign doctors ultimately end up going to the UK or other countries where, having gained experience in Ireland, they can get a career path in those countries.

My understanding is that there is a draft Health Service Executive report on this problem of recruitment which ties in with all the other problems the health service is experiencing but has a significant impact on patients and their families in terms of their access to care, waiting times, appointments, etc., in hospitals and service facilities around the country. Has the Taoiseach discussed this draft report?

Will the Taoiseach make a commitment to the Dáil to publish the report so that we can have a discussion? We do not want doctors in Ireland to be in a version of the gig economy, developing a career in Ireland, either because they are from Ireland or they have come here to work, only to find they are caught in a completely dysfunctional system.

I asked the Taoiseach this morning about the really shameful inequity in the cancer treatment available to people with malignant melanoma. Some people who have the right private health insurance can get access to pembro and other potentially life saving drugs, while others who do not have private health insurance or have the wrong policy cannot. It is shameful that money should dictate access to cancer care which could be potentially life saving. The Taoiseach said it is a complicated situation because the private health insurance company has taken the unprecedented step of moving ahead of the Government in providing cover for this drug. Telling us it is complicated does not answer the question. The national cancer strategy says we should have equitable access to cancer care. Morally, it is just obvious, is it not? What does the Taoiseach have to say to the person who wrote to me whose wife needs this drug and cannot get it? Should she just suck it up that she cannot get access to this potentially life saving treatment? That is just not acceptable. I want to know what to say to this man and his wife and to the many others who have signed a petition on this issue saying they need access to these life saving drugs. They deserve the same chance to live as anybody else, regardless of what private health insurance they do or do not have. What is the Taoiseach going to say to those who need this treatment now?

The vital and often hidden role of healthcare assistants has come to light in recent weeks. A report published on Monday which reviews their role and function is really important and worth noting. It recognises the crucial work of healthcare assistants in delivering high quality care across the health service and calls for a formalisation of the job title of healthcare assistant. It recommends the immediate establishment of a permanent forum which would deal with issues including education, recognition and registration. Has this important report been discussed yet at the Cabinet subcommittee? Will it be discussed? Has the Taoiseach had a chance to have a look at it himself?

On a separate matter, in The Irish Times today, David McConnell and Orla Hardiman raise serious issues about genomic medicine in Ireland, the influence of a Chinese-controlled company, Genomics Medicine Ireland, and the handing over of genetic data gathered in Ireland to this private company. These are matters about which general citizens are concerned. I ask the Taoiseach to examine the matter and to ensure that Irish genomics remain in the public domain and do not become part of a privately owned database for a private company.

There has been great mention of the absence of staffing and staffing levels in various areas of the health service. One of the key things for getting staff into place is having the proper infrastructure in place. That brings me to Sligo hospital, where a cardiac catheterisation laboratory, cath lab, has not been place but has been promised for almost 20 years at this stage. This is getting to be serious because the senior consultant is about to retire. There is great concern that it will be impossible to recruit a senior consultant without having a cath lab. It is a serious problem and needs to be resolved as quickly as possible. I know the HSE capital plan is soon due to come out and we are very much hoping that a permanent cath lab for Sligo will be in that plan. We are not looking for a second one: we are looking for the first one. That is different from other areas which I know are also under serious pressure. Two new wards have also been promised for a long time for Sligo hospital, which is under considerable pressure in regard to numbers and space. This is vital and needs to be in the HSE capital plan and to happen as quickly as possible.

Also part of the same issue of pressure on beds and hospitals are home care packages for the elderly. We have a serious problem with home care packages for the elderly in CHO 1. While it may not be officially stated that funding is frozen, it is effectively frozen. People cannot get access to new home care packages because there is no money to provide them. That is the answer we are getting when we look for them. Every constituency office in the country is meeting the same problem but it is particularly acute in the north west. A new emphasis needs to be brought to the areas that are going to provide the most relief for people. One of them is the home help packages which will have an immediate effect. Another is the infrastructure for University Hospital Sligo.

I thank the Deputies for their questions. On the possibility of the need for a supplementary estimate for the health service, I have not seen the precise comments of the Ministers, Deputies Harris and Donohoe, so I am not au fait with exactly what the difference is. It will not surprise anyone in this House that it is often the case that a supplementary estimate is required for health. That was the case long before 2012. It is not a recent development. It often arises because extra costs arise during the course of the year. One of the extra costs that has very evidently arisen during the course of the year is the cost of resolving the nurses' dispute. We are not going to fund that from cutting services so there are areas where we may need to provide supplementaries later in the year. In the meantime, the Department of Health, the HSE and the Department of Public Expenditure and Reform are working very hard to ensure that the HSE comes in on budget while still accepting that there may be additional costs that arise during the course of the year which will have to be funded.

As to what coming in on budget means, it is important to get this message across if I can. Coming in on budget in the health service this year means spending no more than €1 billion extra compared to last year. It means keeping the increase in spending to about 6%. A €1 billion or 6% increase more than provides for demographics. Perhaps they were not provided for adequately in the past but they are more than provided for this year and last year. The population is growing by less than 1% per year. The population is ageing but not to the extent that it should require an increase of greater than 6% in any one year. The increase for this year is €1 billion. It is what people protesting on the streets are demanding. It was done. We need now to try to come in on budget while allowing a degree of flexibility to provide a supplementary for additional costs that may arise during the year that we are not going to fund by cutting back services elsewhere.

Deputy Martin mentioned that up to 2012, there were never supplementaries in health. That is not true. Indeed, when the Deputy was a Minister himself one year there was a supplementary for €250 million. That was when the budget was a fraction of what it is now.

I was referring to the HSE.

In percentage terms, it was not dissimilar to the kind of overruns we have now. The record for the biggest health supplementary ever was under a Fianna Fáil led Government. About €1 billion had to be provided in a supplementary because of illegal nursing home charges, of which the Deputy will also be aware.

On the recruitment of doctors, all the questions asked by Deputy Burton were asked by Deputy Shortall earlier but I am happy to do her the courtesy of giving the answers again. The Deputy is correct that we have one of the lowest numbers of doctors per head of population in the OECD. Ireland has a relatively low ratio of doctors to patients. In contrast, we have one of the highest ratios when it comes to the nursing profession. We are in the top three, four or five in terms of the number of nurses we have per head of population. I agree that we do not have enough doctors working in our public health service but we do have more than ever before. This often does not come across but there are more doctors now working in our public health service than ever before and more doctors are registered with the Irish Medical Council than ever before. Sometimes the impression is given that there are more doctors leaving the public health service than are joining it but that is not correct.

There are more joining it than leaving. The HSE and Medical Council numbers show that. Overall, the number of people working in the health service has increased by 10,000 over the past three years. It is up from about 105,000 to 150,000 across the public health service. One of the reasons we have overruns in the health service is the recruitment surge rather than the recruitment crisis and the fact that extra people are hired every year beyond what is provided for in budgets.

On the number of consultants working in the public health service, as I said, this continues to grow year on year. The number increased by 109 in the past 12 months. There are, however, significant recruitment and retention challenges, especially in certain specialties such as psychiatry where we need to move to a more psychology based model. It will not be possible to find the number of consultants needed using the current model. In certain locations - some smaller hospitals - particular posts are no longer recognised for training purposes and probably never will be.

The HSE recently prepared a report in response to a request from the Minister for Health, Deputy Harris, and the Department of Health to consider the issues raised in the judgment of Mr. Justice Kelly and given the current recruitment challenges. I understand this report and recommendations were submitted to the Department of Health on 13 May and are currently receiving consideration. They will be published as soon as possible.

Several initiatives are being pursued by the HSE to advance consultant recruitment and retention, including improvements to the recruitment process, which is very cumbersome; offering contracts to the hospital groups rather than individual sites; and focusing on more family friendly arrangements such as job sharing and part-time contracts. The HSE has also established a tripartite working group, including the Medical Council, the forum of postgraduate medical training bodies and the HSE's national doctors training and planning unit, to examine posts where consultants are not on the specialist register and recruitment and retention challenges exist.

While several hundred consultant posts are difficult to fill at present, only 20 are currently being advertised. The reason is that many of the posts are filled on a locum or temporary contract basis to ensure the delivery of essential services. While we describe the positions as being vacant, they are not actually vacant in the sense that the job is being done by somebody on a temporary or locum contract rather than someone on a permanent contact.

On the issue of new entrant consultants' pay and the proposals of the Public Service Pay Commission, the Department of Public Expenditure and Reform has said that outstanding matters will be given full consideration by any pay review mechanism agreed by the relevant parties in the context of the next round of pay talks. In the past few months, we secured a new contract for staff nurses and staff midwives, with pay increases and changes to practices and terms and conditions. We have also successfully agreed a new contract with general practitioners to increase funding for general practice by 40%. In return for that, there have been agreed changes such as the adoption of new technology and GPs taking on new work, especially around chronic disease. In negotiations with consultants we will need to adopt a similar approach in which, in return for equalising pay, we ensure it is not just more pay for the same outcomes and changes are made that are patient focused. It must also deal with some of the very difficult and problematic issues around the mix of public and private practice.

Can I just get my question answered?

I asked about healthcare assistants.

There will not be a third round of questions. That should not be blamed on what happened earlier.

I deserve some answers.

As always, I am happy to continue.

We will not have time for a third round. That has nothing to do with the earlier-----

Perhaps the Taoiseach could come back to us individually afterwards. I asked about healthcare assistants.

I am in the Leas-Cheann Comhairle's hands.

The Taoiseach may continue.

It takes less time to ask a question than it does to answer it, as everyone can appreciate.

On Deputy Boyd Barrett's question, he will appreciate that at this stage I cannot comment on individual cases. We have a system for deciding which medicines are licensed and which are approved for reimbursement in the State. This is not done by private health insurers or the private sector but by public bodies, as it should be. The European Medicines Agency and the Health Products Regulatory Authority decide whether a medicine should be licensed in the State and for what purpose. The HSE, acting on the advice of the National Centre for Pharmacoeconomics, then decides whether a medicine should be reimbursed. Some 30 medicines have been approved this year by the HSE for reimbursement but others have not. If they are not reimbursed, it is often for very good reason. It is not a political decision and I do not believe it should be a political decision.

There is no good reason in this case.

Deputy Howlin asked about healthcare assistants. I am not familiar with the report he mentioned so I will have to check into that. I have not yet had a chance to read the newspapers today but I am aware there is an editorial from Professor David McConnell in The Irish Times today, which I will endeavour to look at. I must read the article before responding.

On Sligo hospital, I understand that a significant new development at the hospital received planning permission in the past couple of weeks. I may be mistaken. The project will be a major extension to Sligo hospital. On the issue of a catheterisation laboratory, I do not know if a permanent laboratory is intended for Sligo hospital. I understand a mobile catheterisation laboratory is provided but it is not the case that the provision of such a laboratory is directly connected to the recruitment of cardiologists. Connolly hospital does not have a catheterisation laboratory, yet it has three or four cardiologists because they do particular types of work, especially in the area of heart failure. I am not able to give the Deputy a detailed reply on that matter but I will ask the Minister for Health to do so.

Cabinet Committee Meetings

Joan Burton


5. Deputy Joan Burton asked the Taoiseach when Cabinet committee D, infrastructure, last met; and when it will next meet. [25593/19]

Mary Lou McDonald


6. Deputy Mary Lou McDonald asked the Taoiseach when Cabinet committee D, infrastructure, last met; and when it is scheduled to meet again. [26555/19]

Eamon Ryan


7. Deputy Eamon Ryan asked the Taoiseach when Cabinet committee D, infrastructure, last met; and when it will next meet. [26620/19]

Richard Boyd Barrett


8. Deputy Richard Boyd Barrett asked the Taoiseach when Cabinet committee D, infrastructure, last met. [26872/19]

Brendan Howlin


9. Deputy Brendan Howlin asked the Taoiseach when Cabinet committee D, infrastructure, last met; and when it will next meet. [27635/19]

Micheál Martin


10. Deputy Micheál Martin asked the Taoiseach the number of times Cabinet committee D, infrastructure, met in 2019. [28207/19]

I propose to take Questions Nos. 5 to 10, inclusive, together.

Cabinet committee D works to ensure a co-ordinated approach in the areas of infrastructure investment and delivery, including housing and climate action. The Cabinet committee last met on 27 May. The next meeting of the committee has yet to be scheduled. There is significant work under way across each of the areas covered by the committee through Government Departments, agencies and a range of interdepartmental groups such as the Project Ireland 2040 delivery board. These matters are also regularly considered at meetings of Government and in bilateral meetings with the relevant Ministers.

Significant progress is being made on the implementation and delivery of Project Ireland 2040 and projects promised for many decades are now well under way. Through the national planning framework, it sets out our strategic 20-year vision for Ireland’s future, balancing rural and urban development and linking it with the national development plan, which encompasses €116 billion in investment in public infrastructure over the next ten years to meet the infrastructural needs of our growing population. In May last, the Government launched the first annual report for Project Ireland 2040 and it is clear it is already delivering better transport links, building new schools, facilitating better health and environmental outcomes and yielding more housing. For the first time in decades, for example, three new hospitals are under construction, while 11 primary care centres will open this year and another 26 are in development. By the end of the year, some 410 school projects will have been completed or will have started construction, providing 40,000 extra or replacement school places, 200 modern science laboratories, 48 new or upgraded physical education halls and the replacement of 600 prefabricated buildings. In addition, work is under way on several long promised projects, including the upgrade to the N4 in Sligo and the new north runway at Dublin Airport.

The four funds launched under Project Ireland 2040 have a total of €4 billion to invest across the areas of rural and urban regeneration and development, climate action and disruptive technologies. The first round of funding allocations under these funds, amounting to just over €300 million, has been announced. These funds will leverage further private sector investment in innovative and targeted projects that deliver on the aims of Project Ireland 2040.

The Land Development Agency, another cornerstone initiative of Project Ireland 2040, was established on an interim basis in September 2018 and is working to ensure the optimum management of State land through strategic development and regeneration, with an immediate focus on providing new homes, including social and affordable housing.

Housing continues to be a priority for the Government and we have seen strong growth in housing completions and leading indicators such as planning permissions, commencement notices and housing registration. Last year, more than 18,800 new homes were built, an increase of 25% on the previous year. More than 2,600 homes were brought out of long-term vacancy and almost 800 dwellings in unfinished estates were completed, meaning the number of new homes available for use increased by more than 22,000 last year. This does not include student accommodation.

There was also strong delivery of publicly funded social housing in 2018. We are aware of significant challenges in meeting housing demand and tackling the ongoing failures in the housing market. For this reason, budget 2019 provided an increase of 25% in the housing budget which, at €2.6 billion, is the biggest ever.

Delivering on our EU climate commitments for 2030 and transitioning to a competitive, low carbon, sustainable economy by 2050 are also priorities. We are investing €22 billion in climate action through the national development plan to ensure that our future growth is regionally balanced and environmentally sustainable.

On 17 June, the Government published the climate action plan, which aims to give Irish people a cleaner, safer and more sustainable future. This far-reaching plan sets out the actions across electricity, transport, heat, agriculture and other areas that we need to take to reduce our greenhouse gas emissions, give us cleaner air and warmer homes, and create the jobs of the future. The plan has a strong focus on implementation, including actions with clear timelines and the steps needed to achieve each action, assigning clear lines of responsibility for delivery. Delivering on the plan will require a deep level of collaboration across Government, and the plan sets out governance arrangements, including the establishment of the climate action delivery board, overseen by my own Department, carbon-proofing of policies in general, the establishment of carbon budgets and a strengthened Climate Change Advisory Council, as well as greater accountability to the Oireachtas through the Joint Committee on Climate Action.

Can we have a detailed, published set of commitments in regard to capital spending for the rest of this year, next year and the year after? That is not a big ask. We are asking to see the capital plan in detail for the forthcoming period. Ironically, we are in a position, as a country, where, technically, we have a capital plan for 2040 but we do not have published capital commitments for the rest of this year and next year. How ridiculous a situation can we have?

I want to ask the Taoiseach about two specific areas in regard to our constituency. First, in general, for women in Dublin and the rest of Ireland, where stands the national maternity hospital? We know there have been dreadful cost overruns and planning failures in the execution of the national children's hospital, resulting in what any chief executive in any organisation would call a complete mess and a complete cost overrun. The Government has put its hands up and acknowledged that. What is the knock-on implication of the enormous cost overrun on the children's hospital for women in Ireland who expect to use the services of the national maternity hospital in a new hospital quite soon?

Second, the master of the Rotunda Hospital, Professor Fergal Malone, wrote a heartbreaking article recently about the pressures under which staff in the Rotunda Hospital, in the centre of Dublin, are working to try to deliver the best services for mothers and babies. As the Taoiseach knows, the Rotunda is meant to move to Blanchardstown. What has happened? We have no idea. The Rotunda itself has no idea what is happening. Is the Blanchardstown move still on? It makes excellent sense but where is the capital plan that would show what is likely to happen? I understand the Rotunda has resources to commit but the State would also need to commit to this.

With regard to another of our maternity hospitals, the Coombe hospital also wishes to see additional investment and, in the context of the children's hospital, the Government has promised a new maternity hospital in respect of the Coombe. Where is that? We have a growing population, which is something to celebrate, but our maternity services are not keeping pace with what is happening in terms of the on-the-ground development of new maternity services for this century for the women of Ireland.

In his statement, the Taoiseach referred to climate change and the climate change actions that are taking place. I want to specifically ask in regard to clean energy, which is one of the core issues. When will we see an end to the use of coal and gas in power stations? Is there a target for when that will happen and how will it happen? At the moment, we are importing coal from Colombia to burn it in Moneypoint, which is a ridiculous situation, even if there was no climate change aspect.

With regard to transport, we need to see additional money being placed in the hands of local authorities to upgrade roads, particularly in rural Ireland, and that needs to happen as quickly as possible. We also need to see infrastructure being built around our rail network, given the many problems, particularly for people coming from the west on the Sligo to Dublin rail line. I was talking to a man the other day who had decided not to drive and to take the train, but he said it was the last time he would take the train because he had to stand the whole way from Leitrim to Dublin. That is a problem we hear all the time from students and other people in the north west, namely, there are not enough trains or carriages and there is no space for passengers.

With regard to the western rail corridor, an issue I have raised previously, it is clear a time is coming when we have to look at the idea of electric rail as one of the solutions from a climate change perspective. This would enable us to move people who commute, for example, from Galway and other areas in the west and north west. It is logical, particularly in regard to the movement of freight.

There is the old chestnut which comes up all the time and which needs to be re-emphasised, and that is the issue of broadband. Whatever company decides it wants to do it, or whatever bid it wants to put in, I keep hearing that it is always next year or the year after. We need to see action on this as quickly as possible.

There are many aspects to the scandal of the national children's hospital and the shocking financial mismanagement by this Government of this project, which is going to cost the people of this country €3 billion. As if that is not bad enough, I am not exaggerating when I say that when I tell people there is going to be a private section to the national children's hospital, they do not believe me - they do not actually believe it. They are absolutely scandalised by the thought that, having paid for this hospital, there will be two tiers of child healthcare. It is outrageous, especially from a Government that says it is against two-tier healthcare, that we are building a state-of-the-art hospital where two-tier healthcare for children is going to be institutionalised.

When I have asked about this, I have been told it is because the consultants' contracts are public-private contracts. I have a solution to this for the Taoiseach. Every paediatrician in the country is going to want to work in the national children's hospital. If they are not in there, to be honest, they are not at the races. Therefore, the Taoiseach has a simple opportunity to resolve this and to remove the two tiers in the hospital so it is single-tier, universal healthcare for our children. He should tell any paediatrician or consultant who wishes to work there that they will only work in that hospital on a public-only contract, which, by the way, is the only sort of contract the State should be giving out for consultants, in my opinion. Will the Taoiseach do that and at least eliminate this scandal in regard to the national children's hospital? It really is a shocker. There are still a lot of people who do not know this but when they hear it, they are utterly disgusted.

When the national development plan was launched early last year, it had already been the subject of the most sustained pre-publicity in our history. The work for the plan was completed about six months before the Taoiseach took up office and, indeed, its details formed a core part of his leadership campaign. Over the following six months, extra years were added to the plan in order to allow more claims to be made, and millions were provided for a marketing campaign.

At the core of the national development plan was a promise that everything was costed and would be delivered within budget, and there would be full transparency. This was going to be assured by actions such as the regular oversight of the Cabinet committee on infrastructure and the real-time updating of information on costs and timescales. That has not happened and there has not been real-time information on costs and timescales. It now turns out some costs in the plan were little better than thinking of a number and hoping to be right. Massive overspending and excessive costs compared to the original estimates are clearly evident and basic information is being withheld. The Cabinet committee last met one month ago and the real-time provision of information stopped as soon as any overspend materialised.

The simple fact is the Government wants to continue advertising its original claims and does not want to acknowledge the impact of major overspending. There is a complete and irreconcilable gap between the reality on the ground and what has been claimed. The children's hospital is now well on its way to hitting the €2 billion mark, which the Taoiseach told us was a conspiracy theory, and the broadband plan is tracking to a €3 billion figure, which was also dismissed until it was exposed. The national development plan is simply not credible until these extra costs have been factored in.

Last year, the Taoiseach was able to issue detailed tables of cost for projects on a regional and national basis. Why is he refusing to update these tables? There is a need for honesty with the public in terms of the impact of the billions of euro in overspend on the Government's plans and projects. Earlier, I asked the Taoiseach about the Dunkettle interchange. I appeal to him not to be petty, silly and idiotic in terms of his response by asking whether I am for or against the Dunkettle interchange. The procurement process is completed. This project was meant to be up and running in early 2018, in terms of construction, with works to run from 2018 to 2022. The indicative cost for this project of €100 million has increased to €115 million. According to the Taoiseach, it was meant to go to construction in early 2019. It is now June 2019. I am hearing rumours that the costs are way ahead of €115 million. Nothing is happening on the site and people are mystified as to what is going on.

With the greatest of respect, people are fed up hearing about 2030 and 2040 and that the Government is going to do this and that. Many projects have been announced for the Cork region. The joke around town is, "Sure, we can't get past the Dunkettle roundabout". That project was to happen years ago. There is need for a reality check in terms of the national development plan, NDP. The Taoiseach mentioned the new children's hospital. The national paediatric model references three regional paediatric facilities at Cork University Hospital, CUH, University Hospital Limerick, UHL, and University Hospital Galway, UHG. These projects are at preplanning stage but we cannot get any information in regard to how much money has been or will be provided for them. The language we are getting from the Department is obfuscation after obfuscation. I am seeking clarity from the Taoiseach on the specific projects I have mentioned. Also, will he commit to update the detailed tables of cost on projects under the NDP for the next four years?

I am always amused and bemused that Deputy Micheál Martin likes to accuse me of being partisan and personal yet, as evidenced by his name-calling today, he is very capable of being partisan and personal himself. The Deputy reminds me of one of those parish priests who preaches from the altar telling us to avoid sin while secretly going behind the altar and engaging in any amount of sin himself.

In terms of capital spending, the budget for health is €10 billion for the next ten years, running from 2018 to 2028. This means the budget for health is double what it was for the previous ten years. Less than 20% of that budget is for the national children's hospital, allowing more than 80% of it to be spent on other healthcare projects in Dublin and throughout the country.

As Deputies will have noted, the summer economic statement provides an extra €200 million in a capital reserve for 2020. This is an increase in the capital ceilings for next year of €200 million. It is being provided to meet the increased cost of the national children's hospital and the national broadband plan. Other projects will not now be affected because the overspend is covered in the €200 million capital reserve that is being provided for next year. What might affect other projects are issues related to those individual projects, be that planning permission, a judicial review or tendering coming in over budget. We are all aware that construction inflation has driven up the cost of building just about everything in the State at the moment. That is not unique to the public sector. It is a feature of the private sector as well.

The capital plan is set out in the national development plan. Deputies will be aware that in 2018 no annual plan was published yet lots of projects were constructed, including primary care centres throughout the country, hospital developments such as the new wings at Clonmel and Limerick hospitals and the Dunmore ring road in Waterford.

On the national maternity hospital, Ireland's first national maternity strategy, Creating a Better Future Together - National Maternity Strategy 2016-2026, was published in January 2016. It represents a significant development in the delivery of national maternity policy that will fundamentally change how maternity care is delivered. This is coupled with the Health Information and Quality Authority, HIQA, national standards for safer, better maternity services and the first ever bereavement care standards. On the development of the national maternity hospital, the Department of Health continues to engage with the national maternity hospital and St. Vincent's Healthcare Group to develop a legal framework to protect the State's significant investment in the new hospital on the campus at St. Vincent's in Elm Park. St. Vincent's Healthcare Group has agreed in principle to provide the State with a 99 year lease of the land upon which the new maternity hospital will be built. This will allow the State to retain ownership of the new facility. The Minister for Health, Deputy Harris, has sought and received the agreement of both the national maternity hospital and St. Vincent's Healthcare Group that the board of the new NMH Dac will be competency based and will include a public interest representative. The Religious Sisters of Charity have resigned from the board of St. Vincent's Healthcare Group and their shareholding is to be transferred to the new company, St. Vincent's Holdings, CLG.

In terms of progress on the relocation project, work has already commenced on the new pharmacy and the extension to the car park. This work commenced in February and is required to clear the site where the new hospital will be built. It is anticipated that the main project will go to tender in the next few months.

On the Rotunda, it is a longer term project. As everyone will know, the Rotunda hospital is moving to the Connolly hospital campus. We are seeking development funding to allow the planning and design phases to begin within the next few months as well.

On the use of coal and gas, it is planned to take coal off the grid in 2025. We would like to do it sooner but at the moment the ESB cannot assure us that it can be done safely sooner because of the risks of brown-outs and blackouts. I do not think anybody wants the type of climate actions that results in brown-outs and blackouts. If it can be done sooner, it will be done sooner but the target that I have is 2025. It is taken offline from time to time already. It was offline for several weeks last year but the ESB is not able to assure us that it is safe to take it offline entirely now. We are not going to impose brown-outs on people. We are going to do this right. Peat 2027-2028 is the plan to take peat out the system.

On natural gas, it is impossible to say. As I said before in this House, it is likely that we will use natural gas as part of our energy mix for the foreseeable future, certainly into the next few decades. When it comes to renewables, we can get to about 70% by 2030 in terms of electricity generation but as things stand there are times when the wind does not blow and the sun does not shine strongly enough. The storage technologies do not exist yet to allow us to store power in the way that we need to. We will need to continue to use natural gas. Absent going nuclear, which we are not going to do, we need to continue to use natural gas as part our energy mix for the foreseeable future.

I did not get a response to my questions, again.

The Taoiseach did not respond to my question regarding the Dunkettle interchange either.

Written Answers are published on the Oireachtas website.