I welcome the Minister back to the House.
Primary Care Centres: Motion
I move:
That Seanad Éireann:
- agrees that the selection criteria for primary care centres prioritising urban deprivation was unilaterally ignored by the Government;
- requests that all documentation be immediately published to clarify how exactly the criteria was changed and the extra centres were selected;
- condemns the cutbacks to front line services particularly bed closures, staff layoffs, and cuts to home help hours as a result of the mismanagement of the health budget which has resulted in €285 million overspend, and
- calls on the Government to reverse these proposed cuts to front line services and to make savings in other areas as outlined in budget 2012 by the Government.
I welcome the Minister back to the House. Notwithstanding all the issues I would like to raise with him, including the issue this evening, he has always made himself available to this House. His record is better than that of any other Minister in that regard. I thank him for that.
With regard to the selection of primary care centres, the issue of prioritising the tackling of urban deprivation was unilaterally ignored by the Cabinet, including the Minister. It is vital that all documentation relevant to the process be made available as a matter of urgency. There has been a ministerial resignation. It is not unprecedented but it is certainly a very serious matter considering the reasons former Minister of State, Deputy Róisín Shortall, gave for her departure.
It has been said on our side of the House by many colleagues that the wrong Minister resigned. While I would have many issues with the Minister and the Minister of State who resigned, I believe it may be easier to shout from the terraces than it is to play on the pitch. Notwithstanding that, the former Minister of State chose to state her reason for resigning was stroke politics. At a time when the entire body politic is in very low standing among the public, whatever remedy is available must be employed. In this context, it is in the interest of the Minister to ensure that any and all documentation, be it so-called commercially sensitive documentation or otherwise on lease agreements that may have been entered into after the granting of planning permission, be made available to the public.
The never-ending and ever-changing story of the primary care centre of Balbriggan, in particular, is extremely worrying. To many objective observers, it appears that the Minister looked after his own constituency when the opportunity presented itself. I refer to the original site being deemed inappropriate, the HSE moving on and the further expressions of interest, after which a site was chosen. All of this occurred on the Minister's watch. He wrote to Balbriggan Town Council to state there was an agreement for a site and a purchase price in principle. That was in July, I am told. Clearly, the Minister was aware that the site was agreed in principle and that the price was effectively agreed. The site happened to be associated with a long-term activist and supporter of the Fine Gael Party.
With that in mind, it is essential that we get to the bottom of this issue. As I said, it appears as if the Minister were looking after his own constituency. He looked after Roscommon because Deputy Frank Feighan took the hit that Deputy Denis Naughten was not prepared to take. The Minister for Health's ministerial colleague, the Minister for the Environment, Community and Local Government, Deputy Phil Hogan, has not been able to deny that he lobbied explicitly for a primary care centre to be put in his area. The reality is that the preannouncement weighting of all of the locations was not consistent with their having been placed in the top 35. That is a concern of the people. The former Minister of State, Deputy Shortall, called it stroke politics and based her reason for withdrawal very specifically on that issue.
I cannot help but notice the absence of a number of Labour Party Senators.
There are three of us present in the Chamber.
There are actually more present that there are Fianna Fáil Senators. It is a Fianna Fáil Private Members' motion. Perhaps the Senator would like to answer that.
I cannot help but notice the absence of certain Labour Party Senators.
What does it say for the Senator's party?
Clearly, it is close to the bone when one considers the amount of heckling and the reaction on the issue. I do not see Senator Whelan, for example, whom I am sure is wondering-----
We do not allude to Senators who are not present in the Chamber.
It is just as well because there are so few Fianna Fáil Members present.
One wonders why a Senator who was most vocal on the issue of Abbeyleix hospital is absent from the Chamber. I am sure he is wondering when the announcement will be made by the Minister, Deputy Reilly. The Labour Party Whip, party leader and spokesperson on health are present but they have to be here. One wonders, however, about their colleagues who have, quite rightly, raised some of these issues in the past.
The aforementioned sideshow is occurring against the backdrop of a floundering health service. There are many isolated issues to celebrate. Some have been pointed out. Earlier, Senator Burke pointed to some developments that are going well. Of course, there are many people working extremely hard and giving very good care to people throughout the country.
There are many isolated issues to celebrate. The Minister has mentioned them. Senator Burke referred to a number of aspects that were going well. Many people are working hard to provide good care throughout the country. However, there is a major issue with cost overruns, the health service's general management and front line cuts. It has been proposed to cut home help hours again. Combined with previous cuts, this amounts to 1 million hours. The HSE will not be in a position to assess each individual case for cutbacks between now and Christmas.
Promises were made. As the Minister is aware, I am on record accusing him of running a deeply cynical campaign from the Opposition benches. He made a series of promises to buy the general election based on a bottom line that he knew could not support the level of expenditure demanded. Promises were made in Ennis and Roscommon, there was going to be a centre of excellence in Sligo and cancer services were to be returned within 100 hundred days, a promise on which the current Minister of State, Deputy Perry, pontificated. All of them have been welched upon and the Minister has claimed that he did not realise that the cupboard was bare. He met the troika before the election was called and knew that the cupboard would not allow him to fulfil promises of that nature. As I have stated on previous Private Members' motions on health, that was irresponsible.
Yesterday, the director general designate of the HSE and the Secretary General of the Department attended the Committee of Public Accounts and were able to clarify that what was a deficit of €329 million had increased to €374 million. With the deficit increasing by €45 million per month, people can legitimately ask whether the Government can continue. Never mind the sideshow of a Minister of State resigning because she has no confidence in her senior Minister, whom she accused of stroke politics and who is clearly looking after his buddies in the Cabinet and his party. Examples include the Minister for the Environment, Community and Local Government, Deputy Hogan, in the case of Kilkenny, and Deputy Feighan in Roscommon, who took a bullet on Roscommon hospital that Deputy Naughten was not prepared to take. The Minister, Deputy Reilly, is also looking after his own constituency. Conveniently enough and as luck would have it, the person who owns the site happens to be a member and supporter of the party. I am not saying that there is anything wrong with that. Ireland is a small country and it is possible to trace a political lineage to everyone. Someone somewhere has had a first cousin who has canvassed for someone else in some party at some time. However and as the former Minister of State, Deputy Shortall, pointed out, this explanation does not account for the agreed and clear criterion of deprivation being unilaterally ignored.
We were told that the Minister consulted his Cabinet colleagues and took advice from HSE officials, but the HSE's director general designate clearly stated yesterday that he was not in a position to confirm that the HSE had anything to do with the site's selection. The children's hospital is due to be built in the constituency of the Minister for Transport, Tourism and Sport, Deputy Varadkar. I wonder whether that had anything to do with his support for the Minister, Deputy Reilly. On "The Week in Politics", he stated that what had happened looked like stroke politics. The Minister for Social Protection, Deputy Burton, and others expressed doubts.
Many of the Labour and Fine Gael Senators who have expressed concerns about, for example, the home help cutbacks and the cost overruns are absent. The overruns were advised by Mr. Cathal Magee as far back as March or April, given the budget set out by the Minister. That budget was dishonest because it was not achievable as far as Mr. Magee was concerned, but he was shipped out of his HSE offices and someone new who was prepared to take over was slipped in. The hospital overruns were predicted by me and many others almost one year ago. Some €124 million was to be saved on drugs and €74 million on the charging for the use of private beds. None of these savings was achieved.
The Senator has less than one minute remaining.
The Minister is trying to defend himself against a growing pool of opposition, possibly within Fine Gael but certainly among some Labour members of the coalition, as evidenced by Deputy Shortall. This situation needs to come to an end.
When the House debated the HSE governance Bill this afternoon, the Minister referred to it as an interim measure to facilitate the abolition of the board. What will it do in real terms? We used nautical terms, for example, the Titanic being called the Olympic. The legislation provides that one needs to have held a position in the old structure to qualify for that position in the new structure. It is a mockery.
I am amazed that the Minister is surrounded by the same people, yet he was the most forthright in condemning the former Minister, Ms Mary Harney, and the previous Government in terms of health. When I was on that side of the House, I probably agreed with him and mimicked much of what he was saying. His press adviser, the spin doctor who is dressing up the Balbriggan issue for him, is the same person who worked for Ms Harney, of whom the Minister was critical.
The Senator has gone way over time.
The Titanic looks the same. It has the same captain. We might be passing legislation to call it by a different name, but the health system under the Minister's administration is littered with broken promises and a cost overrun heading towards €500 million. We do not know how that will be tackled. Given the extra €750 million that must be found in next year's budget, must we find €1.25 billion? The people on the ground want to know and need confidence.
I call Senator Ó Domhnaill.
We are all behind the Minister. All he needs to do is tell us how he will do it.
I second the motion and welcome the Minister to the House. I agree with Senator MacSharry, in that the Minister was always available to attend when required. Some of his Cabinet colleagues could learn from him.
A number of words came to mind while Senator MacSharry was speaking. The Minister undertook the marathon expedition in 2010 and finished the course. It would be fair to say that he is there for the long haul and that Deputy Shortall was there for the short haul and is now gone. Labour Senators may have opinions in this regard and point fingers at this side.
(Interruptions).
If we were in government-----
Never again.
-----and had this scenario unfolded, we know who would have been shouting the loudest. We have a right in opposition to ask the questions to which the people are seeking answers.
Politics is about the art of the possible. Primary care was a fundamental pillar of the programme for Government's health sphere. I agree that the development of primary care is essential if we are to remove the logjam in hospitals. However, this is an issue of how we achieve that and how we select centres, particularly where public private partnerships are involved. Regardless of what happened previously, politics must be renewed.
Another fundamental plank of the programme for Government was a renewed transparency in public office, in the Government and in the Oireachtas, but none of that has come about. This is just one glaring example. In February 2012, the criteria for the selection of primary care centres were agreed between the Minister, the then Minister of State and departmental officials. Subsequently, 15 centres were added to the list. Senator MacSharry has covered most of this aspect of the motion, but how were additional sites added?
This shades the political process and demonstrates political interference in a system where criteria had been agreed by officials overseen by Ministers. If the process and criteria were objective and acceptable internationally, as I understand they were, why was there need for political interference to decide that centres like Balbriggan, which was way down the list of 200 primary care centres, would be selected ahead of Dundalk, which was 21st on the list? The public is asking these questions and although there may be answers during this debate, there has been a glaring omission in providing an answer to those questions.
We all know what happened in Roscommon before the election, when a commitment was given that the hospital would be kept open, but we know what has happened since. There is also the issue of the delivery of two primary care centres in Roscommon. Why close a hospital and then invest money in primary care centres? If all the services available at Roscommon hospital had been kept intact, there would be no need to provide primary centres. There are hundreds of thousands of empty buildings throughout the country and we do not need new buildings in the current climate. We should be looking at empty buildings that can be modernised and refurbished.
Where are they? Who owns them?
I know who owns some of them. They are people with huge mortgages who are struggling to pay them and cannot find tenants for those properties. I am sure they are lobbying Government Members. I know some of these people and I am sure the Members opposite know them as well. If the Labour Party wants new buildings when thousands of empty buildings are available, I cannot see the logic in it. We should look at refurbishment rather than new buildings.
The second part of the motion relates to the cuts in home care packages and home help. The programme for Government indicated that additional funding would be provided each year for the care of older people, with the funding going to more residential places, home care packages and the delivery of more home help and other professional community care services. With cuts of €8 million in home help between now and the end of the year, there will be 1 million fewer home help hours, which will force elderly people out of their homes and into public or private nursing units.
Has the Minister or the HSE the capacity between now and Christmas to assess individually all 11 million hours of home help? How can the Minister state that the assessment process is based on a review of individual needs, which is what is being said locally, when the outcome has been determined? The cuts have been put in place. How can the HSE be sure that cuts to home help hours will not just mean more people will have to avail of full-time care in a hospital setting, which is inevitable?
We are in a time when individuals are being refused a carer's allowance to look after disabled, elderly and vulnerable people. The home help hours are also being cut. We must get a grip. We are either an economy or a society. We will either look after the people who built the country or we will not.
The Senator is way over his time.
These are the elderly and vulnerable. Any cut to home care packages and home help support is a disgrace and cannot be supported.
I call Senator Burke.
This motion is important. I plead with the Minister to go back to the drawing board and rule out any cuts to home help in particular.
I move amendment No. 1:
To delete all words after "Seanad Éireann" and substitute the following:
"— affirms the Minister’s commitment to the aims of the primary care strategy, which has the key objective of developing services in the community, giving people direct access to integrated multidisciplinary teams of general practitioners, nurses, physiotherapists, occupational therapists and others. The continued development of primary care teams and primary care centres are fundamental to making it easier for people to access care closer to their homes;
— welcomes the infrastructure stimulus package within which primary care facilities will be developed at 20 locations across the country using the public private partnership, PPP, mechanism;
— notes that a number of criteria were used in selecting primary care centres for development by PPP. These included the deprivation index for the catchment population, the service priority identified by each integrated service area-local health office, an accommodation assessment, existing health facilities, GP to population ratio, pressures on services, particularly acute services, funding options and the feasibility of implementing the development as a PPP;
— notes that the HSE is facing a significant challenge in 2012 given the need to set expenditure levels within the parameters of the national recovery plan;
— acknowledges the significant reductions which the health sector has experienced over the last three years, both budgetary and staffing;
— notes that the HSE has operated the Croke Park agreement very effectively, with over 3,500 staff redeployed, and a reduction in overall numbers of over 6,000;
— commends the Minister for Health on managing within this difficult environment, and at the same time achieving cost reductions within the health sector which are impressive by international standards, particularly within the hospital sector;
— supports accelerating the type of service delivery reforms that will move to models of care across all service-care groups which treat patients at the lowest level of complexity and provide services at the best possible unit cost; and
— welcomes the Minister and Government’s determination to move towards a health system that provides access based on need rather than income, underpinned by a strengthened primary care sector, a restructured hospital sector and a more transparent "money follows the patient" system of funding that will be supported ultimately by universal health insurance.".
I welcome the Minister back to the House. He has had a long evening here and we appreciate the time given to this matter. The amendment clearly sets out support for the Minister in the work he is doing. It is important for us to consider the overall goal of what we are trying to achieve in reforming the health service. The last part of the amendment states that the Seanad: "welcomes the Minister and Government’s determination to move towards a health system that provides access based on need rather than income, underpinned by a strengthened primary care sector, a restructured hospital sector and a more transparent "money follows the patient" system of funding that will be supported ultimately by universal health insurance".
We made it quite clear when we came into Government that the introduction of universal health care would take a number of years, and there is a process that must be gone through in implementing it. There is a step-by-step approach, with one such step being primary care units. On 17 July, the Minister for Public Expenditure and Reform, Deputy Howlin, announced an infrastructure package of €2.25 billion, with €115 million allocated to two bundles of primary care. Initially, the idea was for 20 primary care units identified that could be developed, and another 15 were added. I wonder how the other side of the House would have reacted if the Minister announced today that there would not be an additional 15 units? How would the people who will benefit from the additional 15 units feel towards the Opposition if they were suddenly withdrawn? That seems to what the Opposition wants but the Minister is not prepared to do it. He wants to use the money and the opportunity available to him to develop primary care units in the maximum number of areas in the fastest possible time.
The criteria are quite clearly set out, with a number of issues taken into account. For example, elements include the deprivation index, the service priority identified by each integrated service area, the accommodation assessment and staff surveys. Additional criteria include competition, GP co-operation and the population being served by general practitioners. Pressure on services, particularly acute services, have been taken into account, as well as funding options such as Exchequer funding, builder lease and implementing public private partnerships. All these elements have been taken into account when the Minister has considered primary care.
My colleague across the House asked why we do not examine the potential use of unoccupied buildings. In constructing a health care centre, certain standards must be reached, and not every building can be adapted to cater for health care. In many cases it is probably cheaper to construct a brand new building than adapt an existing building. We must consider such issues. We have identified 35 areas where primary care units can go ahead, but we must go through a process, and they will not suddenly appear overnight. The locations have been identified but the type of building required, for example, must be determined. We must make progress.
On Monday there was a letter in the Irish Examiner arguing that there has not been a health care sector in Ireland for decades. We now appear to have gone down the road of hysteria, with people convinced there is no health care sector in place. I can give out figures repeatedly. In fairness to previous Ministers, much development has taken place in the health care sector over the past ten, 15 or 20 years, although we could have done more. We must get on with the process at this stage. The fear being put into people's minds is a concern because people are very worried.
I had a group of people in the House today who raised a number of issues on health care and they did so as a result of the amount of media attention these issues have been given and because the problems have been over-exaggerated.
I will cite some examples I gave earlier. In regard to maternity care, the number of deliveries a year has increased from 55,000 to 74,000. We have the lowest perinatal mortality rate. Outpatient attendances have increased from 2 million to 3.5 million. Some 31,700 people per working day attend for outpatient consultation, even at a time when money is scarce the number of people with medical cards has increased from 1.146 million to 1.8 million. Some 130,000 people have a GP-only card.
That has to do with unemployment.
The Government is being criticised for not doing enough in health care. More than 23,000 people are supported under the fair deal scheme which costs more than €1 billion. This is what the Minister has been doing and what he wants to do is to get better value for money.
Since the Minister came into office he has €1.7 billion less in his budget to use yet the services being provided have improved. The criticism being levelled against him is not in order. He has done a very good job in the time he has been in office. We have a lot more to do and let us keep working towards achieving that. In fairness to Opposition Members, some constructive amendments were put forward in the earlier debate today and the Minister has taken on board some of those and given them serious consideration. Having worked in Brussels, I believe we need to work more together. In terms of the fear that has been put into people's minds, we need to change that focus in the way we deal with this debate.
I will not say too much this evening other than that I would share some interest in seeing a little clarification on the decision-making process that was involved in the primary care centres, but I will not be supporting this motion. I am not a party member. I was a fairly vocal critic of aspects of policy of the outgoing Government. Since coming into this House I have worked very closely with members of the dominant party in the previous Government and have forged good working, personal and professional relationships with them and I am glad we were able to advance a number of issues related to health care and other aspects. I look forward to working with Senator White on important legislation relating to retirement age. I have been privileged to work with Senator Daly on our anti-smoking legislation and with Senator MacSharry on legislation seeking increased clarity, transparency and consistency in the approval of cancer and other high-tech drugs.
However, on this occasion I will not be supporting this motion and I hope there will be an understanding of my position on this. While there is a need for clarity on the decision-making process that went into the primary care centres, the wording of this motion is unduly critical, censorious and makes certain assumptions about the process which are not as yet borne out by facts in the public domain. As such, I cannot support the contention that the Government unilaterally ignored well-established criteria. I look forward to hearing the Minister's exposition in the House today as to exactly what those criteria were.
There is something else I want to say and it is a very instructive illustration of how the process of politics works. I must admit that on a personal level I am far less cynical about the politicians who occupy these two Houses than I was before I became a Member of this House. I am, if anything, more cynical about the process of politics. The systems which have been put in place have enforced certain behaviours, namely, that of flip-flopping. When people are in opposition they will oppose cutbacks, when they are in government they will enforce cutbacks and when they are back in opposition they will oppose them again. Patronage will be dispensed by parties in power and it will be opposed by those in opposition until they are back in power when they will again dispense it. In our political system where in truth - do not take this personal, guys and girls - there is very little between the parties ideologically or in terms of convictions, matters such as patronage become issues. There is inevitably built into the reality of the system a certain amount of playing of politics and parochialism. One can understand how Roscommon hospital which lost its 24-hour access might feel there was a gap in terms of pre-existing medical care which needed to be plugged and that a primary care centre would legitimately provide some of the coverage for that. I look forward to hearing what has to be said about this.
I like giving the Minister a little back stiffener every time he comes into the House and I want to give him another one now because his reform programme is one that I support. To give Members a quick picture of the vision, some people see things and ask why and some see the others and ask why not. Let us look at the "why not" argument. Let us imagine a system where everybody has a single negotiable insurance instrument which may be provided by a private insurance company or by the State, one which is based on a fixed percentage of one's income where richer people subsidise the poorer people but at the end of the process everybody has a solitary instrument, a card, a computer chip or whatever, which gives them the same rights of access to the same health systems without any fear or favour, that they can go to any institution they wish and take part in the same waiting process and, hopefully, they will not be waiting in such a system. Some of the hospitals and doctors they elect to go to might be employees of the State, employees of the universities or other not-for-profit private entities. Some may be completely private practitioners. There will be sufficient policing in place to make sure that there was no cherry-picking or price gouging, that there was not supplier-induced demand, as we call it in health economics, where doctors prescribe unnecessary procedures in order to increase their throughput and line their own pockets. It is a system which has complete empowerment of the patient at its core. The patient chooses where he or she goes. It is not chosen by some nameless bureaucrat. It is a system which involves tackling the greatest vested interest in our health system now, which is one that never gets mentioned, which is the permanent government, the bureaucracy, the Civil Service and the HSE, a group which needs to be challenged. It is a system which would put in place patient-derived forces which would have the effect of enforcing responsible behaviours on doctors, which would open the market by employing more doctors and which would end waiting lists because people do not get paid until they do what they say they will do. They do not get paid for being merely in a job; they get paid for producing.
This is the vision that we need put in front the Minister. I will support him on his journey to it. I am very keen that he will try to accelerate that move, that implementation. I am sure there would be goodwill all around the House for that. I see a number of other issues which arise on the way to that nirvana as being perhaps more in the nature of distractions than true progress. We are hoping that the Minister will accelerate this process and move quickly because this is not some vague goal we should think about in a second term of office. This is something we need to acknowledge, as is what we need to do to fix the system. Palliative administrative and bureaucratic band-aids over the system we have now will not fix the fundamental problems which are inequity, poor quality and inefficiency.
I welcome the Minister to the Chamber. I find Senator MacSharry's concern for the Labour Party deeply touching and I thank him for it. His contrived annoyance becomes a little threadbare when we take a look at his own side and point out to him the lack of senatorial colleagues of his own party-----
Do not burn any bridges.
-----who have come into the House to support him.
We could also mention Dungloe and ask Senator Ó Domhnaill if he has identified any sites in that area-----
It is not built yet.
-----or shall we take the Senator at his word and place the primary health care centre in a three-bedroom, semi-detached house, as he is proposing?
That is being flippant. There are buildings that could potentially be suitable.
Can the Senator in possession deal with the substance of the motion and not personalise the matter? I am not sure what Senator MacSharry said but Senator Gilroy is only enticing backchat and it is not helpful to the order of the House.
That would not be my intention.
I welcome the motion before us because it gives us a good opportunity to discuss primary health care and it is probably the most important element of health care delivery that we can examine and it is also a very important part of the programme for Government. However, the blatant and undisguised party politicisation of the debate is to be regretted, and I am sure the Leas-Chathaoirleach will agree with that.
I am certain our colleagues on the other side of the House will agree with me when I say that the provision of primary care and primacy care infrastructure is one of the more important elements of reform that we can achieve in this term of Government.
We will resist the temptation to point out that the current dysfunctional condition of the health service is a legacy of mismanagement of the system by the previous Administration that we inherited. We saw in yesterday's histrionic behaviour at the Committee of Public Accounts that evidence of this dysfunction remains. It appears that the need to score party political points outweighs the requirement for calm and measured debate. Undoubtedly there is a level of frustration with the manner in which certain elements of health care is provided in this country but it can hardly be addressed by stagecraft or amateur dramatics, either in this House or elsewhere.
Health care has been prioritised in the programme for Government and funding has been allocated for the provision of this vital infrastructure. This will not only go a long way towards addressing the existing inadequacies in the provision of primary health care but will also act as a stimulus to the wider economy through the provision of much-needed employment in the construction phase of such developments. The motion before the House appears to be an amalgamation of everything. It was obviously put together by a committee in an attempt to score as many political points as possible. In its thoroughness it forgets that the problems highlighted in the motion can be attributed to and traced directly back to the failures of the previous Government. It will be supported and voted for by Members of this House who, probably out of a sense of embarrassment or decency, have decided not to turn up for this debate.
In light of this, the Government amendment is reasonable and can be supported by all Members of the House, including those on the Opposition side. The delivery of primary care in an integrated fashion is a major step forward and in the current constrained economy represents an ambitious but deliverable project. It is regrettable that this work was not undertaken when there were ample funds available. The funding available for it now is something of which the Minister for Health and the Minister for Public Expenditure and Reform can be proud and they can take some measure of satisfaction in its delivery.
The delivery of health care in a timely fashion based on need and delivered as close to home as possible at the level of least complexity can be achieved. This underpins the strategy of health care delivery in this country. Public private partnerships have worked well in the past, particularly in the delivery of vital infrastructure, such as roads. We have seen this in some of the projects delivered under the previous Administration, to be fair. For too long, however, we have spoken about health service reform. We all agree that the previous Government's effort in this direction through the establishment of the HSE represented an honest but ultimately unsuccessful attempt to grapple with the problem. The legislation before the House seeks to deliver the most fundamental reform of the service since 2004 and will probably go a long way towards addressing many of the legacy issues in that regard. This Government has moved very quickly and the Minister is to be commended on that.
In supporting the Government's amendment we can all look forward to the day in the not too distant future, when the people of Ireland will have the health service they need and demand.
Fáiltím roimh an Aire. Tá sé thar a bheith tábhachtach an rún seo atá os ár gcomhair inniu a phlé agus tá mé ag éisteacht go cúramach leis an méid atá á rá ag an bhFreasúra. An tseachtain seo caite, nuair a d'árdaigh mé an cheist seo, bhí mé ag moladh go mbeadh rún againn os comhair an Tí maidir le muinín nó easpa muiníne a chuir san Aire, bíodh sin bealach amháin nó bealach eile. Bhí cuid mhaith de chomhghleacaithe an Aire i bPáirtí Fhine Gael nach mbeadh fadhb dá laghad acu le vóta muiníne a chur ann, agus bhí go leor daoine sa bhFreasúra ag rá gur bhreá leo rún mímhuiníne a chur ann. Ar bhealach, is é atá ag tarlú anseo.
Tá an fhoclaíocht atá á úsáid ag daoine iontach suimiúil. I note that part of the Government amendment "commends the Minister for Health for managing within this difficult environment, and at the same time achieving cost reductions within the health sector which are impressive by international standards, particularly within the hospital sector". I take it from that wording that Fine Gael and the Labour Party are voting confidence in the Minister. Obviously, we will not be supporting the amendment. However, it is quite interesting, particularly coming from the Labour Party Senators. It appears to be very much at odds with statements from other party members. I might refer to them later.
I welcome the Fianna Fáil motion, which we will support. There are two primary issues in this debate. The first is the manner in which the Minister, Deputy James Reilly, has conducted himself. We believe he has not explained in a credible way his decision to promote two towns in his constituency to higher places on the list. The effect of this was to allow these two areas to have a status that means they will now have primary care centres. The logic formally given for the Minister's promotion of these two sites appears to be of Einstein-like complexity, notwithstanding the fact that we would not begrudge a primary care centre for any area that needs one. We believe the Minister persistently misled the House about his business connections with Seamus Murphy and the consultations he had with senior Labour Party Ministers about expanding the number of health care centres. He is dodging questions and failing to answer them clearly. I hope he takes this opportunity to answer them.
There is a certain sense of arrogance and bluster, which has only increased public suspicion that the reasoning was purely cynical and self serving. The Minister's insistence that there exists a logistical logarithmic progression is meaningless and needs explanation. Quite honestly, the dogs on the street and particularly the people who use the health services really do not believe the answer being put forward by the Government on this issue. The Minister and the rest of the Government must come clean about the basis for adding these 15 centres. That should be a very straightforward operation. The support of the Labour Party for the Minister over its own Minister of State with responsibility for primary health care is another let down for voters. Deputy Eamon Gilmore and the Labour Party have backed the Minister, Deputy James Reilly, throughout all of this and the Labour Party must take responsibility for its part in the Government too.
The second issue is the real reason the Minister should resign, namely, we believe he is doing a very bad job. The Fine Gael and Labour Party coalition has been running the public health services into the ground. The people look to their leaders to do the right thing, but Fine Gael has failed the people on this and has failed to legislate to reform the health service. We all know these are tough times and that tough decisions must be made, but this is a question of choices. Where is the legislation required to cut consultants' pay and to recoup moneys from private health insurers?
The recent controversy was sparked by cuts of €130 million announced by the HSE. This was in addition to €750 million taken out of the health budget in 2012, which itself followed a €1 billion cut in 2011. Recent Social Justice Ireland reports point out that during this time the income of our wealthiest citizens increased and billions of euro were handed over to bad banks. We do not see the Government tackling those groups of people. It appears that this Government will always take the easy option of cutting the services for the vulnerable.
Another issue has been glossed over in this debate. We are talking about building primary care centres, but what about the staffing of those centres? I can offer an example from Spiddal in County Galway. Spiddal has had a primary care centre for a number of years but it has never been fully staffed. It has never had the full complement of occupational therapy, physiotherapy, speech and language therapy and other services. There is the issue of building primary care centres but there is also the issue of staffing them. This debate is taking away from the fact that while primary care centres might be built in cahoots with private enterprises, those centres must be staffed to ensure the people who need the services will get them.
Recent Government policies could put lives at risk in the interests of the profits of private insurance companies who provide care for money. We oppose the Government's amendment as we believe it ignores the reality of the health system. The Labour Party and Fine Gael said they would lift the ban on ongoing recruitment. They have not done so and are therefore forced to pay for more overtime and additional agency staff. Those extra costs mean that cuts in front-line services are inevitable. I saw that last week with the closure of a day centre in Carraroe. We were told that because agency staff could not be brought in and extra staff had been taken out of the public system to be put into Owenriff Nursing Home in Oughterard, which fell foul of a Health Information and Quality Authority, HIQA, report, there were not enough staff to keep the public service open last week. One cannot pull €1.7 billion out of the health service and expect front-line services not to be affected. That is fairytale politics and economics. Citizens deserve better and more honest policies.
We have tabled an amendment to make the motion more sensible. It is our position that Fianna Fáil's motion makes no sense or is at least incomplete. Its statement that cuts should be made elsewhere is vague. Where does that party think the cuts should be made? Is it in education or rural transport?
The point is the failing health system is a symptom of a failing economic policy, which means that policy needs changing. That was backed up yesterday by the IMF annual report, which stated that austerity is not working. However, the present Government and its predecessor had their heads in the sand in that regard. They do not want to read this and do not even want to admit it. The confidence of the people in the health care system has been limited in any case and for good reason. The actions of the Government and the air of stroke politics arising from the Minister's recent decision have made this worse. As Phil Prendergast, MEP, has stated, this is the sort of politics that has brought us to ruin. The people are losing faith in their Government to do the right thing. Are Nessa Childers, MEP, Phil Prendergast, MEP, and others in a different Labour Party?
The Senator's time is up.
I have not heard any Labour Party Members tonight expressing full confidence in the Minister. However, if they vote in favour of the Government amendment "commending the Minister for Health for managing within this difficult environment", that is what they are doing. Ba mhaith liom go smaoineoidís orthu féin faoi seo sula ndéanann siad é mar ní dóigh liom go bhfuil muinín againne as an Aire. Níl muinín ag an bpobal as an Aire. Níl muinín ag a chomhghleacaithe as an Aire agus ní cóir dóibh vótáil ar son leasaithe an Rialtais.
I welcome the opportunity to speak on this motion and in support of the Government amendment. The central objective of the Government's reform programme is to deliver a fair, efficient, single-tier health service supported by a strong primary care system and underpinned by universal health insurance. The latter will mean people are treated on their need; not what they can afford. The programme for Government sets out a clear pathway for the future development and strengthening of the services, notwithstanding the enormous financial challenges the Government inherited. Despite the challenges posed by reducing resources, it has already made significant advances in improving services and delivering on the commitments it made in the programme for Government. I will provide examples to give Members a flavour of how much things are changing. Earlier today, I stated there had been an improvement of 22% in the number of people who are obliged to wait on trolleys. I have just received the latest figures, which indicate a reduction of 23.8%. This is real and measurable and the people concerned are real.
I acknowledge there are still too many people lying on trolleys and we must and will do more. I mentioned earlier the reduction, from an all-time high of 569 patients on trolleys only last year in January 2011 to a figure of 139 on 7 September 2012, which is a 75% reduction. Overall surgical waiting list numbers have decreased in the last year by 7%, while each time band has seen a substantial reduction with those waiting more than 12 months down by 85%, those waiting over nine months down by 63% and those waiting more than three months down by 18%. In addition, I note there are 800 fewer children on waiting lists. There has been the establishment for the first time of a national office of clinical audit, NOCA, for surgery, critical care and orthopaedics. For the first time, the country now has 24 hour a day, seven days a week thrombolysis coverage, which means that all hospitals that receive stroke patients and treat them have a stroke unit. The statistics currently available indicate this is saving one life a week, as well as saving three other citizens from entering long-term care.
The average length of stay has reduced from 8.7 days to 7.9 days. The rate of readmission from heart failure has been reduced from 27% to 6.3%. A national education programme for asthma is now operational in primary and secondary care. Four 24 hour a day, seven days a week percutaneous coronary intervention, PCI, centres are in place to enable the percutaneous insertion of stents for acute heart attacks. This development is real and now means that someone who experiences a coronary occlusion - who previously would have had a heart attack and died - can be saved. Not alone can such a person be saved but instead of being a cardiac cripple lying in a bed for eight weeks, he or she will leave hospital after 48 hours. These are real achievements that affect the lives of citizens.
In the area of mental health, three significant programmes are being designed in areas such as self-harm and eating disorders. Moreover, an integrated care model for diabetes and other chronic diseases is being put in place. In emergency medicine, all 28 continuous improvement implementation teams are in place. Moreover, 30% more patients are being seen in dermatology and rheumatology clinics and national audiology screening of 99% of children within four weeks of birth is in place. There is much more, including the productive theatre initiative, the money-follows-the-patient initiatives, the change such clinical programmes have brought and the money this has saved in respect of bed-days saved. The savings amount to 70,000 bed-days, or €63 million, and there will be more this year. As part of the reform programme the Health Service Executive (Governance) Bill 2012 has been published and was debated in this Chamber earlier today. This provides for the abolition of the Health Service Executive, HSE, board and its replacement with a new directorate and governance structures. A director general-designate has been appointed and already is taking action to change and reform the system.
The Government's primary care strategy is one of the key pillars of the reform programme in health. The key objective of this strategy is to develop services in the community that will give people direct access to integrated multidisciplinary teams of general practitioners, nurses, physiotherapists, occupational therapists and other health care disciplines. A modern, well-equipped primary care infrastructure is central to the effective functioning of primary care teams. The infrastructure development, through a combination of public and private investment, will facilitate the delivery of multidisciplinary primary health care and represents a tangible re-focusing of the health service to deliver care in the most appropriate and lowest cost setting. It is the intention of Government to develop as many centres as possible by one of three separate methods, namely, direct investment, that is, Exchequer-funded HSE construction, by way of leasing arrangements and through public private partnerships. The Minister for Public Expenditure and Reform, Deputy Howlin, announced the Government's €2.25 billion infrastructure stimulus package on 17 July. This will provide investment in a range of important new projects. The infrastructure stimulus package announced by the Government involved projects that would meet key infrastructural needs in line with the priorities identified in the Government's investment framework. They would form the first phase of a new programme of public private partnerships, PPPs, designed to stimulate economic growth and create employment. A total of 35 potential locations for primary care centres have been published. Of these, approximately 20 will be commissioned subject to agreement between the local GPs and the HSE on active local GP involvement in the centres - because otherwise one merely would be building empty palaces - and site suitability and availability. It is envisaged the locations will be offered to the market in two separate bundles. The current position is that the HSE is engaging with the National Development Finance Agency as required to progress the primary care centre public private partnership programme. The HSE is currently analysing the available sites in each location and engaging with the GPs in each location to determine their interest in participating in the primary care centre development.
I believe it is important to report on the progress achieved to date in the area of primary care. In order to achieve savings in health spending while also reforming and improving the health service, it is imperative that we develop new models of care. Primary care should be able to meet 90% to 95% of people's health needs and through modern and strengthened primary care, we can achieve much better health outcomes and much better value for money. I look forward to working with the Minister of State, Deputy Alex White, in ensuring we achieve this. In January, the universal primary care project, UPC, team was established to drive the implementation of the primary care reform. The projects overseen by the UPC team include policy, planning, costing and legislative preparation for the extension of free GP care and the preparation of legislation for this key reform is at an advanced stage. It also oversees the development of implementation plans for chronic disease management in primary care and preparation for a new GP contract to reflect the programme for Government commitments to universal free GP care and intensive chronic disease management. All this change, however, must take place in the context of a very difficult budgetary environment.
The HSE budget has been reduced by €2.5 billion over the last three years. The number of health service staff has fallen from a peak of 111,000 in 2007 to fewer than 103,000 now. As all Members are aware, the country still faces serious challenges in respect of the public finances. Further measures to address the deficit were submitted to the troika in July including accelerated cash collection from private insurance income, use of capital funding for revenue on a once-off basis, savings in 2012 from agreement with the pharmaceutical industry, additional once-off funding arising from an agreement with the Medical Defence Union and once-off transfers of funding from the Department's Vote.
Proposals for the achievement of additional savings of €130 million were announced by the HSE in August. Almost 50% of the savings are to be achieved from more focused cash and stock management initiatives, savings in medical equipment - non-capital, furniture, education, training, office expenses, travel and subsistence and advertising. The remaining 50% will be achieved through efficiencies in disability services, home help hours, home care packages, agency and overtime payments.
As Senators are aware, Government policy is to support older people to live in dignity and independence in their own homes and communities for as long as possible. The demand for home supports will increase in the light of changing demographics, needs and wider system pressures. This has obviously been a challenging year for the health services overall, including maintaining services in line with evolving resource pressures. Decisions in regard to the provision of home help hours will continue to be based on a review of individual needs, and no current recipient of the service who has an assessed need for this will be left without a service.
Ongoing reductions are being applied to HSE-funded disability services generally as part of the general Estimates reductions, with savings generated focusing mostly on consolidation and rationalisation of back office costs to protect front-line service delivery as much as possible. The HSE is continuing to examine options for savings from other sources to limit further the impact on front-line services.
In addition to undertaking measures to address the immediate position, the Department has been undertaking strategic measures to address the ongoing financial issues in the HSE. A review of the financial management systems in the Health Service Executive was commissioned in May. The review team came up with a number of recommendations to improve the financial management process within the HSE, and PA Consulting was engaged to draw up urgent measures to be put in place in regard to the HSE's financial management and processes having regard to the findings and recommendations of this review. It was also requested to stress test the HSE's July cost containment plans, analyse the effects of the plans on scheduled and unscheduled care and identify potential structural cost savings in the acute hospital sector. The consultants' report is due to be submitted to my Department shortly.
I would like to address some of the issues raised and comments made. Senator MacSharry spoke about me being downright irresponsible. I have to put it to him that there could be no greater example of downright irresponsibility than the throwing away of our financial sovereignty. The only stroke here is from the masters of strokes themselves who want to spin a good yarn to distract from the real issue which is the mess left by the previous Government which we must clean up, and in health, that mess is as big as anywhere.
There is also a contention that we have the same captain and we are just moving deckchairs on the Titanic. We have already had a long discussion in the House about a new director designate for the HSE.
He is the same.
There is a new Secretary General in the Department of Health and a new chief executive officer and a new chairman in the VHI. Things have changed greatly, and will continue to change. I said previously that as we reach that point where the status quo is really changing, the noise and din from those who are comfortable with that status quo, which does not put patients first, will grow to a deafening din, but so be it. We are committed and we are going to do it. There is no turning back for me or for my Government.
Roscommon hospital was mentioned and it was said that if it had not been closed, there would be no need for primary care centres. I would say to Senator Ó Domhnaill that that is to totally misunderstand what health reform is about. It is about moving patient care to the lowest level of complexity that is safe, timely, efficient and as close to home as possible. Clearly, there is a deficit in primary care in the Roscommon area which has to be addressed, and all the more acutely because of the fact the accident and emergency department in Roscommon hospital no longer functions as it did. We have had that debate before and we know that the service there was not safe, as determined by the Health Information and Quality Authority. I am pleased to report an ever-increasing footfall in Roscommon hospital in terms of new facilities and new services, including plastic surgery and rheumatology to mention but two. Bill Maher continues to focus on moving more stuff from the bigger hospitals to the smaller ones, which is as it should be, and, indeed, from the hospitals back to the community in primary care.
As I said, the home help reduction should not result in anyone losing out. No one who is assessed as needing a service will be left without one. As I said, I very much look forward to working with the Minister of State, Deputy Alex White, in regard to primary care and to continuing my work with the Minister of State, Deputy Kathleen Lynch, in regard to mental health, disability and older people.
Senator Ó Clochartaigh has abused his privilege in this House by suggesting that I have any business relationship with Mr. Seamus Murphy. I do not and I have said that outside the House and inside it. I challenge Senator Ó Clochartaigh to repeat that outside the House and to deal with the consequences. When he talks about credibility, I find it difficult to stomach it given that his party leader still tries to tell us he was never a member of the IRA. However, what I found even more disturbing was the shroud-waving engaged in by his party in February. Pregnant women expecting the joy of a new child were told by his party spokesman that they would not have a safe service and cancer patients were told they would not be able to get their drugs. The case proved to be utterly false and not only did we maintain a safe service but, as I outlined, we have improved it in so many ways.
There is much more to be done; I do not deny it. I remain as committed as ever to doing that. I remain more determined than ever to make it happen but, mostly, I am more convinced than ever that we will achieve it because of the excellence of the people working in the health service and the new leadership that is emerging, both clinically and managerially. I commend the amendment to the motion.
I welcome the Minister but I regret that no officials from the HSE or his Department are here.
He does not need them. They have more important work to do.
The Minister is alone, but he is in good company at the same time. Having been a Minister of State in his Department, it sounds like a much more exciting place than when I was in it between 1987 and 1989. Hawkins House was not quite as dramatic.
Take him back.
I would like to know if the Minister did give delegation to-----
The Senator should stick to the current situation.
I think I am sticking very closely to it. I will develop my argument as I go along, so wait in anticipation. Did the Minister actually delegate responsibility to the former Minister of State, Deputy Shortall? It is a very important point.
I can answer that question. She was given a delegation-----
I thank the Minister for that because that is not always the case in his Department. Between the Minister and the Secretary General, there has been much toing and froing in the past. Having been a Minister of State in that Department, all I can say is that if one is delegated responsibility, one works in conjunction with, consults and shares responsibility with one's Minister. One does not go on a solo run in regard to a particular project.
They seek them here, they seek them there, they seek them everywhere, the elusive primary centres in Boyle and Ballaghaderreen. They are not there. There is no contact, no evidence and no site. Will they ever be built? They will be a poor substitute for an accident and emergency department in Roscommon hospital.
We have often heard the letters of St. James. By God, they are nothing like the letters of James the apostle here when he assured the people of Roscommon that, in accordance with Fine Gael policy on local hospitals, it would retain the emergency, surgical, medical and other services at Roscommon hospital. The alleged, the so-called or the possible centres in Boyle and Ballaghaderreen are no substitute for an active accident and emergency department in Roscommon hospital.
We have a new primary care centre in Roscommon but only one practice and one chemist shop went into it, along with HSE staff.
In Ballaghaderreen nobody has come forward with a site and no site has been identified and no doctor has been contacted.
A site will be obtained.
In Boyle a new centre has been built by Dr. Loftus and his team at enormous expense and it is functioning very satisfactorily. There are other doctors in Boyle and, perhaps, they will avail of the Minister's generous offer. I can give one assurance as a practising politician. Balbriggan health centre will be built and occupied.
As will the others.
Balbriggan will be the first primary care centre in Ireland to be opened.
Nearly as good as Roscommon.
When I went into the Department of Health and Children I got the file on Roscommon County Hospital and was shocked when I read the proposal at that time, which I had to ensure would be reversed. I know a good deal about local politics and about ensuring that one's constituency is looked after in a proper manner. All I can say to the Minister in that regard is, "So be it". I make no personal allegation about the Minister in this regard. He is looking after the interests of his constituents in Dublin North and is serving them well. He follows fine representatives from that constituency over a long period who served in the other House, all of whom were very colourful. Dublin North always produces the most colourful, effective and efficient Deputies and when they become Ministers they certainly look after their constituents.
The Senator is colourful.
I will tell the House about stroke politics. When the Minister for Public Expenditure and Reform, Deputy Brendan Howlin, put €20 million into Wexford General Hospital for a new accident and emergency unit, the Government of which he is a member closed the accident and emergency unit in Roscommon hospital.
I welcome the Minister of State at the Department of Health, Deputy Alex White, to the House.
I also welcome him and congratulate him.
Senator Leyden has me confused. I wish the Minister of State well.
Well done to the Minister of State and I congratulate him. I welcome him back to the House.
Senator Conway's time is disappearing.
I will take my time because the previous Senator-----
He used fewer than five minutes.
He ranted but we are well used to it at this stage. I welcome the newly-appointed Minister of State, Deputy Alex White, to the House. He is a gentleman I do not know well, except by reputation, and the reputation is strong. His work as Chairman of the Joint Committee on Finance, Public Expenditure and Reform certainly received a number of plaudits and I am sure the members of that committee are disappointed he is moving on. However, the Government is delighted that a steady, safe, strong, competent, capable and deliverable pair of hands is taking over the realms of primary care.
Róisín was that as well.
Primary care will improve; there is no ifs, ands or buts about that. The 35 primary care centres identified by the Minister, and more, will be built in the lifetime of the Government. In recent weeks the Minister is more determined than ever to deliver on primary care and he has a good Minister of State to ensure that will happen. I can assure the House the delegation orders are signed and that the Minister of State will deliver on primary care. Primary care is extremely important. It is a pity it is politicised to the degree it has been in recent weeks. It is a political issue but it is not a party political football. We have had enough of that from all sides of the House in the past 15 to 20 years. The health service was gradually dismantled in the past ten to 15 years and has to be rebuilt. Unfortunately, as the sections are spread all over the place, trying to get a handle on how bad it is, and a handle on the overspends and the phenomenal waste of money that has taken place in the health service in the past decade, will take time.
While the Minister is doing that he is also trying to formulate a plan and impose his ideology. He is also trying to improve the structures, as we saw in the Health Service Executive (Governance) Bill debated earlier, and trying to ensure that accountability stays with the Minister and Ministers of State and is not kicked off to the Health Service Executive as happened under previous regimes, which legislated to ensure they were not accountable and could kick the ball forward. We have had to legislate to bring that back to ensure that accountability lies with the Minister. That has been achieved in the legislation. In fairness to the other side of the House, some interesting amendments were proposed to the Bill which the Minister will take into consideration. It must be acknowledged that he was fair and reasonable in the parliamentary discourse that took place today.
In general, there is much positivity in health. Primary health care will be the big ball issue in the coming years that will be delivered but a number of other deliveries are also taking place. The bones of €2 billion has been taken out of the health service and there has been improved delivery. Waiting lists are being reduced. Roscommon hospital provides a great service in plastic surgery and other areas. I spoke with people in Roscommon last week and they are absolutely delighted with the service.
One cannot get plastic surgery in Roscommon if one were dying.
The scaremongering that took place in Roscommon was a bag of wind. Slowly but surely the Senator will realise that.
The Senator should worry about Ennis hospital and not Roscommon hospital.
Deputy Luke 'Ming' Flanagan and the Senator's colleagues will realise that in due course.
We have had the Crowley value for money report on funding for services for people with disabilities. I commend the former Minister, Mr. John Moloney, who realised that money was being squandered on disability services that were not getting to the people in need of such services. In fairness, he commissioned a report under Laurence Crowley which confirmed the squandering of money by the Government in the previous ten years on disability services. That party has the gall to go on national and local radio and speak about the attempts by the Government to pull back some of the waste of money. I commend Laurence Crowley for his report but the dirty work will have to be done by the Government to try to rectify the problem and ensure the waste is stopped, including the vast sums of money, €3,000 and €4,000 per week, paid to chief executives of NGOs. One particular chief executive of an NGO was in receipt of approximately €500,000 per year. We have to clean up all that skulduggery.
What about the consultants?
We will do it. Every month there will be progress and by the end of the lifetime of the Government people will get a fair day's wage for a fair day's effort. More than €1 billion has been pumped in, which is adequate to provide support through the myriad NGOs around the country who are doing that work. Those NGOs will be accountable and the bonuses they have paid themselves, through voluntary collections and which they refuse to declare to the Government, will be tidied up. We will see be a proper, transparent, accountable health service.
I second the amendment. I wish the Minister of State, Deputy Alex White, the best of luck in his difficult task in the country's interest.
It is my pleasure to welcome the former Senator, now Minister of State, Deputy Alex White, to the House. He will be diligent in his new position. Having sat beside me during the term of the previous Government, I know he is a dedicated politician.
Owing to the Whip system I will have to vote with my colleagues. I had the privilege of serving with the Minister for Health, Deputy James Reilly, on the Joint Committee on Health and Children for two years. He knows his business upside down and inside out. I am prepared to give him a chance. The gossip is demeaning and brings politics into disrepute. What is happening is taking from the serious work that has to be done in the complicated issue in the Department of Health and the HSE. I also support the Minister because of his vision and strategy for the health service.
I am totally opposed to the dual health service here where a rich person can go to the Blackrock Clinic the next day but a poor person must wait a year. The Minister's strategy is to have a fair and efficient single-tier health service supported by a strong primary care system and underpinned by universal health insurance. That is why I support his vision and strategy. We are here to change the health system and to turn it upside down and change it inside out.
Well done, Senator.
I would like to raise another issue with the Minister of State. I am concerned about the proposed €65 million cut to disability and home help services.
Senator Conway has left but he is au fait with the massive inefficiencies of the service. I will follow the matter myself and track it. I want to ensure that every person who needs help receives it and we all have a moral responsibility to ensure that happens. We should not disregard the newspaper headlines that people in receipt of disability or home care packages will lose them. The media has dragged politics into disrepute and the situation is getting worse by the week. The media tries to entertain the public who are already cynical about the Seanad and the Dáil but politicians are being labelled as lazy.
I feel honoured and privileged to be a public servant. As John F. Kennedy said: "Ask not what your country can do for you; ask what you can do for your country." I had the privilege of being very close to President Kennedy when he came to Dublin and visited Dublin Castle in 1963 - and I will tell Members about that on another occasion. On this day 50 years ago he responded to the Thalidomide birth defects crisis by signing an amendment to the Federal Food, Drug and Cosmetic Act that required pharmaceutical companies to prove that their products were safe and effective prior to marketing. He understood how important it was for his nation to know that this poisonous drug was not approved for sale in the USA. We were not so fortunate here with just 32 survivors alive after 50 years.
The Fine Gael Party gave a commitment in its programme for Government that it would deal with the issue and properly look after the needs of the 32 Thalidomide survivors. No one ever believed that the survivors would reach 60 years of age because it was believed that they would die when they were about 20 or 25 years old. It is a scar on the reputation of the Irish State that the group has been so badly treated. They have not even received an apology from the State. President Kennedy had the guts and knew that it was not correct to allow the drug to be sold. Not only was the drug allowed into this country, it was still on shelves in pharmacies around the country a year later when people knew it was poisonous. I would like to see the issue resolved. The Thalidomide group has decided to take the matter to the courts. The Minister for Health said that he would do his best to resolve the issue when he came to power. The former Minister for Health, Mary Harney, and the Fianna Fáil Party failed to deal with the issue and adopted a flippant attitude towards it. I was the group's champion in the previous Government and I arranged for many of the survivors to meet the Fianna Fáil Parliamentary Party but I was shocked at its heartlessness because it could not even make an apology on behalf of the State. I wish the new Minister of State the best of luck in his new role.
I call on Senator Bacik who has six minutes.
I welcome the Minister of State, Deputy Alex White, to the House. It is a pleasure to have him back here in his new capacity as Minister of State and I am delighted to see him. I am sure, and I hope, he will be a regular visitor to the House. We also appreciate the presence of the Minister for Health for more than half of the debate and for responding directly and personally. It was important to us that he did so.
We have listened to speakers from the Fianna Fáil Party go on at length about flaws in the health care policy of the Government. Senator White differed by acknowledging the Government's radical reform programme and made favourable comments about it. I agree with her that we have had inequalities in the health care system for far too long and they are unsupportable. It is hard to accept criticisms from a party that governed during prosperous times yet increased the inequality in the health care system and presided over disastrous policies like co-location, the initiation of a consultant contract of which it is now critical, and the growing inequality and long waiting lists that we had even in the boom. We easily forget that during the Celtic tiger there were huge problems with the health care system and there was no attempt made to carry out a systemic reform that the Government is committed to.
I am proud to be part of the Government because and I shall quote the programme for Government which states, "This Government is the first in the history of the State that is committed to developing a universal, single-tier health service, which guarantees access to medical care based on need, not income."
Senators
Hear, hear.
The document bears rereading because it is clear and unequivocal in its commitment to a radical reform of the health care system. It also clearly states that this is the first Government that will do that.
It is quite different from the manifesto.
Both Government parties had manifestos based on radical reform. The programme continues, "This Government" is committed to introducing "Universal Health Insurance with equal access to care for all." The programme acknowledges, as do Ministers, that reform will not be easy and will be a difficult process that will take a little time. It is a process that is well worth carrying out and has already started. It is due to the radical reform that we have seen reform in primary care. That is the first step. Following the commitment to universal health insurance given in the programme for Government, there is a commitment to introduce universal primary care. That is a radical new proposal that will be brought in through an ambitious four-phase programme that will ultimately result in free access to GP care.
An integral part of primary care reform is the idea that a stimulus package would be provided and the Minister referred to it in his speech. Such a package would include - and it was announced as part of the infrastructure stimulus package announced by the Minister for Public Expenditure and Reform, Deputy Howlin on 17 July - projects to meet key infrastructure needs in line with priorities identified in the investment framework, including primary care centres. Some Opposition Senators have been critical of the idea of building new primary care centres but I disagree with them. It is our strong policy to have new primary care centres. I have had direct experience of them in other countries such as Spain which has an excellent primary care network. They have a one-stop-shop in local communities with access to GPs, dental treatments and a range of treatments that most Irish people must go to hospitals to access. A move towards primary care centres is progressive. The building of centres is also part of a job creation stimulus package.
I am delighted that the Minister of State, Deputy White, will drive forward the reforms. Clearly, there have been frustrations caused by delays in rolling out the four-phase programme for primary care. Steps have been taken. It is important that we push the programme forward and see it as part of the overall package of health reforms.
I pay tribute to the former Minister of State, Deputy Shortall, and thank her for her pioneering work in primary care. She also pushed forward a very important health measure for dealing with alcohol abuse. I know that her replacement, Deputy While, will progress her work.
The Seanad Public Consultation Committee recently held good hearings with NGOs and groups working on preventive health strategies, particularly cancer prevention. I look forward to sharing the findings of the public consultation committee with the Minister of State and the Department of Health. Health strategies are an important part of a health care system. It is also about cost saving and ensuring that people have access to health care at the earliest possible opportunity.
All of these radical reforms would be difficult in the best of times but they are particularly difficult in the current economic climate. The Government's amendment makes reference to that. It points out that the Minister for Health has managed an impressive cost reduction in difficult times, that waiting lists have reduced, and we have all heard the figures, and that the Croke Park agreement has delivered real results in the health care sector. Health service staff reductions amount to over 6,000 people yet we see efficiencies are being delivered. It shows the achievements that can be gained with greater efficiency through the Croke Park agreement.
It is also clear that the Minister inherited problems such as budgetary strategy and financial management in the Department of Health. We are changing that through new changes to HSE governance.
We have inherited the HSE, a creation of the previous Government. It is important to ring fence budgets in the way we ring-fenced the mental health budget under the Minister of State, Deputy Kathleen Lynch. In primary health care the programme for Government provides for ring-fencing for additional psychologists, counsellors and community mental health teams.
I was delighted to hear Senator Crown voice his support for the amendment and for the Government's reforms. We need to keep in our sight the very radical nature of the reform being introduced and the vast amount of work it will take as well as the critical goal we all share of access to health care on the basis of need rather than on means.
I welcome the Minister of State, Deputy White, my former colleague from the Oireachtas Joint Committee on Finance, Public Expenditure and Reform, to his new post. He was a brilliant Chairman of that committee and the expertise in finance he will be bringing to the Department of Health is most important. I wish him well in his role.
I wish to outline some thoughts about primary care centres. In the past we had dispensaries and we had a choice of doctor schemes. I have some concerns and hope this has been properly costed. In the past medical graduates used to convert the garage or the front room of a house into a GP office. If we get the State and public private partnerships involved - I know the Minister of State has an interest in that from his previous role - will we just end up with the money going to builders, auctioneers, bureaucrats and so on? It was a simple product and many people would say that the GP service was the one that did not fail. People did not have to wait for years to see a GP. I wonder if, following some of the recent controversy, it might merit re-examination. What was wrong with what we had previously with physiotherapists and others setting up practice at home? While it was not a one-stop shop, let us ensure we are not creating a new cost base and involving the State in new capital expenditure.
The Department's document indicates that we have invested approximately €5 billion in health capital projects in the past ten years. Some of it was used earlier than that to convert hospitals such as Dr. Steevens' Hospital into offices. It is a heavily bureaucratic service and I hope the Minister of State will be able to run that down. Based on numbers discussed in the earlier debate with the Minister, Deputy Reilly, the fastest increasing area of the health service since 1980 has been in the number of administrators and clerical people. This is about people treating patients.
We need to speed up the introduction of universal health insurance. Some 36% of the population have medical cards and there are other grades of medical cards. As approximately half the people already have private health insurance, let us go for it. I hope the Minister of State will get an opportunity to review a version of the Milliman report on hospitals and the VHI that is less redacted than the one supplied to us. We have a very long average length of stay. I note from the Minister's speech that this has been reduced from 8.7 days to 7.9 days. However, the Milliman report gave an example of a treatment that would take 3.7 days where best practice applied internationally and took 11.6 days here. That adds approximately €1,000 a night to every in-hospital treatment covered by VHI.
The report also stated that very little analysis, appraisal and value-for-money research has been done within VHI to ascertain whether health insurance prescriptions and the overall costs were unduly high. I had hoped that competitive health insurance would drive down costs and excessive lengths of stay. There is material on that matter that the Minister of State might like to look at. My amendment was to move faster to universal health care provided it is done in a competitive way so that instead of saying that a particular company charges less for health insurance because it cheated by recruiting only young people and not old people, one would rather say it was because the VHI had had a monopoly with too many monopolistic habits. If old people can be allocated equally among all the competing insurance companies, we would get better value.
I have heard GPs make a further point - one the Minister of State and I would have had in common in a previous time as members of a board of a university. Milton Friedman and Simon Kuzsnets, both Nobel Prize winners, said in the 1940s that if the American Medical Association were allowed to determine who could go to medical school and what foreign doctors could practice in the United States, it would result in a very expensive health service. I believe they were right given that it accounts for approximately 17% of gross national income in that country.
What kind of health service would we have had if universities had not been so adept at turning away students with 550 points seeking to enter medical school in the past 25 years? Would that have given a much more patient and consumer-orientated service? Was it good value from the national point of view that these highly qualified and talented people who wanted to study medicine and had all the points were kept out? There was a particularly daft attempt to weight that through the HPAT because too many women qualified - this was opposed by the Minister, Deputy Reilly, and also the former Senator, Dr. Mary Henry. Keeping out of medical school some of the most talented people the country has produced over the past 20 years must have had knock-on consequences for the service the Minister of State is seeking to organise in the consumer's interest. Perhaps he might also review that matter.
The Minister also spoke about public private partnerships which really need to be examined. In other fields, as the Minister of State will know from his time as Chairman of the Oireachtas Joint Committee on Finance, Public Expenditure and Reform, the results were doubtful. I believe in a public sector and a private sector. When they come together, I am not so sure that the public sector has typically got a good bargain for the citizens as a whole.
The Minister of State is very welcome to the House and I hope he comes here many more times. I wish him every success in his new role. As we said to his senior colleague, the Department of Health has been the toughest job in Irish political life for a very long time - it has damaged the political careers of many who have held ministerial office there. It is most important that the Government succeeds and I wish the Minister of State well in his endeavours.
I acknowledge the presence in the Visitors' Gallery of the former Minister of State, Ms Mary Wallace, and other visitors, who are very welcome. It is good to see them.
I offer my congratulations to the Minister of State, Deputy White, and I wish him well particularly in the implementation of the primary health care programme. I am delighted that the Minister, Deputy Reilly, was present earlier to speak on the motion. Much has been made of him having been constantly critical of the previous Government's health policy when in opposition. While I accept he was critical, at the same time he was developing a roadmap on how to introduce universal health care, which is now part of the programme for Government and will be implemented within two terms of office. He did not spend the entire time in opposition throwing stones - he spent time researching how we would develop and implement the universal health care model, a major plank of which is primary care. I believe he has hit the ground running since coming into office.
Earlier this afternoon we had Committee Stage of the Health Service Executive (Governance) Bill, which changes the structures of how the HSE operates. Primary care is about delivering services as close as possible to people in the community. It is particularly important for those with disabilities and the elderly. The Minister of State comes in at a very fortuitous time with the announcement of the stimulus package in July. The Government has published the list of 35 primary care centres.
I take issue with the motion in the name of the Fianna Fáil Senators, which asks the House to agree "that the selection criteria for primary care centres prioritising urban deprivation was unilaterally ignored by the Government". However, this was not the case. The 20 primary care centres that were selected on the basis of deprivation are included in the Government's list.
What about the other 15?
The stroke related to the other 15.
Senator Clune without interruption, please.
There is one in my constituency in Togher, which has been neglected for many years and I am glad to see it has been included. Deprivation is one of the many indices that have been used. Anybody who has any experience of trying to get a primary health care centre developed knows how essential it is to get GP buy-in.
Proximity to a Minister and broken promises were the other criteria.
There was also the question of whether they would be done by public private partnership, leasing or developing by the State.
The public private partnership model has been used here successfully, although I admit there is need for some oversight in this regard to ensure we are getting value for the taxpayer. I have no objection to the leveraging of private funding for projects we cannot afford. I was a member of the Committee of Public Accounts which examined the issue of public private partnerships. We have gained some experience, in particular in terms of the provision of schools. Much expertise in this regard has been built up in the relevant Department.
They are great at logarithms.
I have confidence that public private partnerships can and will deliver, with the necessary supervision. The Minister listed in his speech the improvements made since he took up the health portfolio, in particular the reduction in the number of patients on trolleys, the reduction in surgical waiting lists, the establishment of the office for clinical audit, the criteria for orthopaedics and so on. Many changes have been made. I commend the Minister on his work to date.
The Croke Park agreement has delivered in terms of the implementation of necessary measures. I am sure Senators Colm Burke and Gilroy, both of whom are also from the Cork area, will testify to the many changes that have come about in Cork in terms of reorganisation of health services there. We have been briefed by officials from the HSE on the successes achieved under the Croke Park agreement. Necessary changes, such as the movement of orthopaedic services from St. Mary's Hospital to the South Infirmary-Victoria Hospital, would not have been possible but for the co-operation of staff as per that agreement. It has been successful despite the loss of staff. This needs to be repeated often.
I commend the Minister on the important work he has done to date. I wish him and the new Minister of State, Deputy Alex White, well and assure them of my support and, I am sure, of this House for the work they are doing. It is very important we move to the delivery of primary care in the community, taking the emphasis off hospitals on which we have been dependent for too long.
I wish to share my time with Senator Thomas Byrne.
Is that agreed? Agreed.
I welcome the Minister of State, Deputy Alex White, to the House and congratulate him on his appointment. I wish him well.
Primary care is essential. It is important to emphasise that it will ultimately save money in the health service. There is a need for greater emphasis on programmes which encourage people to avoid incurring medical conditions which are not good for them or the Exchequer.
Members on this side are condemning the cuts in this area, in respect of which the Minister of State is opposing us. When previously a Member of the Seanad on this side of the House, the Minister of State did as we are doing and we opposed him. This is part of the cynicism surrounding politics, as mentioned by Senator Mary White.
When it comes to the budget and overruns in the health service, it is inexplicable that the serious overruns identified in the early part of the year are to be addressed between now and the end of this year. When the district hospital in New Ross closed, a number of people came together, took it over and operated it as a community hospital. Each month the board of directors were given information on hospital costs for the previous month, how this compared with the previous year and projections and forecasts to the end of the year. Everyone knew exactly what was going on and if corrections needed to be made, they were made immediately. We did not wait until the end of the year to do so. It is obvious there is not in place in our health service the required management personnel to carry out these functions, which is serious. This issue needs to be addressed.
The appalling attitude of the witnesses who appeared before the Committee of Public Accounts yesterday typifies the reason our health services and finances in that area are as bad as they are. There are too many administrators in the health services. I was critical of the proposal to establish the Health Service Executive as I believed it was a flawed model and doomed to failure because there were no intermediate checks at regional or county level. Oireachtas Members and councillors could play some role in relation to the delivery of services in their areas and monitoring of funding in this regard.
Another issue which needs to be addressed and for which I have been calling for a long time is that of costs across the public service, in respect of which I accept we on this side of the House must accept some blame. The level of salary being paid to hospital consultants in this country is scandalous. Some 500 consultants are on salaries in excess of €200,000 and the salaries of many others are just below that threshold. I recently spoke to a hospital consultant, who is surgeon in Italy. His salary is €5,000 per month which amounts to €60,000 per annum. Consultants here are being paid three times that amount. This issue needs to be tackled, otherwise patients will suffer. This is not fair or justifiable. This issue needs to be tackled if we are to have fairness and equality in our system.
I thank Senator Walsh for sharing time with me. The reason we are opposed to these cuts is clear, namely, they target the most vulnerable, including those in need of home help and those who are disabled, while nothing is being done to tackle the drugs bill. I am not sure if the Bill dealing with this issue has been introduced in the Dáil yet. Implementation of that would result in savings of €10 million. However, the Minister, Deputy Reilly, has sat on his hands in respect of the Bill. I sincerely hope the Minister of State, Deputy White, whom I congratulate on his appointment, will not do that.
It is hoped that the primary care legislation, which is promised in the programme for Government but on which nothing has happened, will be introduced, thus providing the Minister of State, Deputy White, with delegated powers. Until then, he will be at the whim of the Minister, except in the specific functions delegated to him, including the poisons Bill and other issues which do not affect the public.
A stroke was pulled in relation to the provision of the new primary care centres. Senator Clune said 20 centres are required. If she is correct, the proposal to provide 15 was wrong. The reality is that on the day they were announced-----
Senator Clune did not say that.
-----as part of the stimulus package, every Senator and Deputy in the areas connected with these centres issued statements welcoming their construction. It became apparent later that only 20 of the 35 announced in the stimulus package would be built. Senator Leyden referred to the lack of progress being made in Boyle and Ballaghaderreen. The same applies to Kells in County Meath, which was one of the 15 locations added to the list of 35. There is nothing happening in relation to the provision of that primary care centre. I raised this matter on the Adjournment last week. Negotiations collapsed in 2010. The Minister said in this Chamber last week that the HSE is seeking to resurrect those negotiations. I do not believe they can be resurrected if they broke down in 2010. Shame on the Minister for Health to announce a centre in Kells when there appears to be no foundation for it. This appears to be the pattern throughout the country, except as mentioned by Senator Leyden, in Balbriggan and Swords.
I am opposed to the health policy being devised, which is based on competing insurance companies.
It is based on equality and need.
People will be offered competing insurance. It is a privatised version of the health service, with insurance companies deciding what people can have. They will purchase the health care and will have control over the hospitals. I do not accept the HSE is the failure which everyone paints it to be. At the end of the day, the HSE is a public health service purchasing public health care for the public good. The Government proposes to change this. It will be regrettable, if it ever happens.
The next speaker is Senator Harte, whom I understand is sharing time with Senator Moloney.
I welcome the Minister of State, Deputy White, to the House. I was listening in my office to the contributions of various Senators. The contribution from the Sinn Féin Member in relation to home care was hilarious. During a telephone conversation with a friend of mine from Strabane, I was told the residential home there is due to close shortly. A number of other homes in Northern Ireland are also to be closed by the end of this year or early next year.
Tax generating powers will sort that.
Senator Harte, without interruption, please.
I previously lived in Lifford, which is about a mile from Strabane. Everyone in Donegal is aware of the threat of closure of Lifford community hospital, which is a residential home.
For the past two or three years Sinn Féin councillors and Deputies have been jumping up and down on platforms stating how disgraceful this is, while a two minute jog away on the other side of the river there is not one peep out of them about the closure of Greenfield House. In 2009, a Sinn Féin Councillor in Strabane, Jarlath McNulty, stated, "Most Greenfield residents have been there long term and to be forced to move out of familiar surroundings and away from friends and care staff at this stage would be extremely traumatic and detrimental to their health and wellbeing". This is the same party which issued a statement today-----
Is Senator Harte not aware of the block grant? Must I explain it again?
I am aware of the residents of Greenfield.
Tory cuts from Westminster.
Sinn Féin is implementing the Tory cuts.
I ask Senator Harte to stick to the motion.
Senator Ó Clochartaigh does not live near the Border. I was born in Lifford and lived there for many years. Strabane is as much a part of Ireland as Galway is but the residents of Strabane do not get the same treatment. The residents of Greenfield House have been told they will be turfed out. The same councillor-----
The residents of Carraroe are also affected by cuts to old people's homes.
Sinn Féin is implementing Tory cuts. We are implementing cuts imposed by the EU but in the North Sinn Féin is part of a government. We are trying to solve the problem, but in Northern Ireland Sinn Féin is complicit with the Tory Government. Sinn Féin should not blame the Tory Government, it should blame its leaders and the people who are implementing these cuts.
It has no control over the block grant.
Forget about the block grant.
It is all about the block grant. If we had devolved powers we could raise our own taxes.
The only partitionist party in the room today is Sinn Féin because it distinguishes between residents in Strabane and Lifford. They can be sure-----
The greatest load of waffle.
I know where the waffle is coming from. It has been coming from the Sinn Féin representatives in Donegal who have attended meetings I have also attended-----
So Senator Harte has full confidence in the Minister, Deputy Reilly.
-----and castigated the Government on every occasion.
Good man.
They have repeated what Mr. Jarlath McNulty said across the Border about the mental health and well-being of the residents-----
Stand by your man.
Sinn Féin should be honest with the people and tell them why it is doing it. It is doing it because it is in government in Northern Ireland and must do it. However it comes down here and tells us to do something different.
We have no fiscal powers. That is why we are doing it.
Sinn Féin has no powers whatsoever.
No fiscal powers.
It has no powers.
No fiscal powers.
Obviously it has no powers.
Does Senator Harte know what fiscal powers are?
I will say one thing.
Fiscal powers relate to raising taxes.
Sinn Féin may not have powers but it has the power to protest and make statements. A statement was issued from Stormont this evening, but no statement has been made about Greenfield House or the care of the patients there. Why not?
Tell me about Carraroe. Tell me about the people down here.
Please stick to the motion.
I am not here to defend the Minister, Deputy Reilly, or any person. I am here to defend the Government and the actions it is taking on primary care. I am well aware of the future of primary care for my children and their children, and it is important we put it in place and not end up back where we were in 2010.
Like other Senators I welcome the Minister of State, Deputy White, to the Chamber. I am sure when he was sitting here he did not think he would be sitting where he is now. Well done and congratulations. There is no better man to take over the portfolio.
I will keep my comments brief because I know we have time constraints. People have spoken about empty buildings throughout the country and wondered why primary care centres are being built. It is because they will be purpose-built and building them will create employment. When they are built and operational the rent from GPs will go to the State and not to private developers. I will stand over this any day and it is a good thing.
The special delivery unit which was established is definitely showing results and reducing waiting lists throughout the country. It is a step in the right direction. Much more must be done of course, and as Fianna Fáil used to say, a lot done and more to do. We all echo this sentiment. We know there is much work to be done but we are here to do it and we are up to the job. Of course it is with great regret that Deputy Shortall did not see it through because she had many good ideas. I hope the Minister of State, Deputy White, will take over the alcohol legislation and see it come to fruition. It is Labour Party policy to drive primary care centres so I will not apologise to anyone for doing it. We will continue to do it and that is what we are here to do.
Reference was made to home care packages. No cuts were made to home care packages and funding was increased. This is to be welcomed, particularly in this climate when funds are scarce. I am concerned about those who receive home help hours. I hope the Department will consider the person at all times. At a HSE meeting we were told home helps are paid by the hour and we must get value for money. Of course we do, but we must remember we are speaking about vulnerable people. I hope the Minister of State will do what he can to ensure those who receive home help will have their hours maintained.
HSE areas which keep within their budgets should not be punished through cuts being made. I ask the Minister of State to examine this. I know it is early days for him and he is finding his feet. The Department of Health is a poisoned chalice, as Fianna Fáil knows. In fairness to Fianna Fáil, it kept pumping money into health but it did not work so we had to pull it asunder and reform it. We could not have begun the process of reform without the Croke Park agreement and keeping people on our side and working. We all recall that prior to the election nurses were out with placards seeking a reduction in hours. Under the Croke Park agreement this has gone away. I urge those who want to break the Croke Park agreement to keep it going.
It is a long time since I have heard such a disjointed and scattergun approach to a motion before the House. Senator MacSharry's speech was an exercise in innuendo, speculation and gossip. He even raised the subject of the children's hospital and suggested if it were built in any Minister's constituency Fianna Fáil would suggest it was due to the influence of that Minister. Only a few weeks ago, the leader of Fianna Fáil in the House stated a site had been available free of charge in Balbriggan since 2002. If it was available since 2002 why did Fianna Fáil not build a primary care centre in Balbriggan?
Senator Ó Domhnaill suggested we should build primary care centres in ghost estates. No wonder the country was in the state it was and that the Government inherited such a system. It would certainly take more than 18 months to solve the health problems we have, but the Minister outlined the Government's achievements over the past 18 months. There is no question that there is much more to be done. It cannot be achieved in 18 months.
Sinn Féin wants the Minister to resign but we take that with a grain of salt. It wants a utopian situation with a fairy tale system as the Senator mentioned.
I did not mention it at all.
It wants to throw more and more money at a myriad of problems, a policy which has failed the country and has plunged it into bankruptcy.
Why does the Government not tackle the consultants?
Senators know the criteria used for selecting 20 primary care centres under the PPP. I will outline the additional criteria applied by the Minister, Deputy Reilly, and I will be clear, so do not say I am not clear. They were competition; GP co-operation; GP to population ratio; a cost effective GP buy-in; existing health facilities; pressures on services in areas, particularly acute services; funding options, including Exchequer funded HSE build or lease; and the ability to implement a PPP. These are the clear criteria the Minister applied-----
When were they made up?
-----and the Department of Public Expenditure and Reform accepted the Minister's thinking that competition was required to ensure cost effective GP buy-in. On this basis the number of potential primary care centre locations was determined. Senators now know the criteria. They are clear and concise. By deciding to create a list of 35 rather than 20 the Minister, Deputy Reilly, provided positive encouragement for enlargement and financial participation by GPs in this significant and important stimulus package.
When dealing with public private partnerships, it certainly makes sense to maximise the options available. This Government will not be blown off course by motions such as we have seen before the House today. We have committed to fixing the broken country and health service we inherited. The Minister and the Ministers of State, Deputies White and Lynch, certainly will not fail. They have outlined the achievements to date. There is much to be done and we will deliver free GP care and so many other things promised in the programme for Government in the five year term of this Government. The Opposition can talk all it likes and throw at us whatever it wishes, but we will deliver. This is a Government that is united in reforming the health service and the team that is in place will deliver that reform.
The Senator should ask Deputy Shortall about that.
As Senator Cummins had some spare time, I will allow Senator Hayden two minutes in which to make her contribution.
I will be very brief. Sometimes one looks at the Opposition benches and says "fair enough, a real issue". At other times, one looks at them and thinks that the issue raised is so cynical, it is beyond expression. I am reminded of the best example of cynicism in the political system, which was the decentralisation process engaged in by some of those now on the Opposition benches who, when in Government, gave a new meaning to the phrase "one for everybody in the audience". I congratulate the Minister for coming to the Chamber today. He showed real courage and a willingness to explain himself in the face of what can only be described as a somewhat cynical attack.
My grandmother had a series of hats in her wardrobe and she always told me that if one waits long enough, it will come back into fashion. To some extent, what we are looking at now in respect of the primary care programme is history repeating itself. I am reminded of the closures of the cottage hospitals during the 1970s and 1980s where we were far too quick and willing to look to centralisation and centres of excellence. As we look into an Ireland where we facing an ageing population, primary care centres are the future. I welcome the Minister of State, Deputy White, to the House. This is one of the most important programmes this Government will embark upon and wish the Minister of State the best of success.
At the outset, I am delighted my former colleague and very good friend outside the ring has been promoted. There is no better man to come up the curve quickly and do all that is necessary in pursuit of his work. That is genuine.
Hear, hear.
Will the Senator withdraw the motion?
(Interruptions).
The Acting Chairman cannot allow this heckling to last five minutes as I have a lot to answer. I always welcome the Minister to the House. I said at the very beginning of this debate and all day how appreciative we are of him making so much time available. He is the only Minister with that kind of record. We have had all the Ministers in the House at different times. He always comes to the House and we genuinely appreciate that.
The Minister stated that I said he was irresponsible. Indeed, he was irresponsible and reckless in the promises made before the election. That is a fact. Those promises were made on the back of a budget of which the current Government and former Opposition was aware. It met the troika just as we did. The cupboard was as bare then as it is now. No one said to Senator O'Keeffe, a candidate for the Dáil at the time, to promise a centre of excellence in Sligo. No one told the Minister to write that letter we heard Senator Leyden read out in respect of the promises to the people of Roscommon. The Government knew the promises were not deliverable . They should not have been promised. That was irresponsible and politically downright reckless. I described it before as political delinquency, and that is what it was.
As much as I welcome my friend and congratulate him on his elevation to Minister of State, and while I have no axe to grind and hold no bars in respect of the former Minister of State, Deputy Shortall, the reality is she resigned for a reason. She was close to it and chose what many of us might feel was an easy option, to shout from the terraces instead of playing on the field, but she did it for a reason. That for me demands, as we say in the motion, that the Minister publish all the documentation to do with these locations. We are all in favour of primary care centres, universal health care and new GP care, but where are they? It does not concern the 20 locations that were chosen, rather it concerns the 15 sites. How did we pick them? If one is in Dundalk, which is 21st in the ranking, one would wonder why its primary care centre location did not get up the curve. We want all 400 of them as quickly as resources will permit. I have no doubt the Minister of State will ensure this is done as quickly as possible, to the extent to which resources are available. However, the reality is that 15 locations were chosen. How were they chosen? I venture it was done on political grounds. It was a case of choosing one for the Minister's constituency and two in Roscommon to look after poor Deputy Feighan who took the bullet Deputy Naughten was not prepared to take.
The Senator is judging the Government by his own standards.
That is not what happened.
As for cynicism-----
(Interruptions).
Senator MacSharry, without interruption.
I congratulate the new Labour Party Whip. If she was here long enough, she would know that the most cynical campaign ever carried out in opposition was by the then shadow Minister, Deputy Reilly. That is a fact.
Of the current cuts, front-line cuts are all over the news. All Senators are fielding complaints in their constituency clinics about cuts to home help hours - hours cut to half hours, half hours cut to 15 minutes and 15 minutes disappearing. That is what we are all interested in here. In terms of the achievements, I have never doubted what Senator Crown rightly said earlier on. Some people see things that are and say, "Why", and others dream things that never were and say, "Why not?" I have said many times that I do not doubt the vision or commitment of the Minister and his team to what they want to achieve. The reality is that we are 18 months in but where are we? We had a €329 million overrun in August, which some months later has risen to €375 million. Yesterday, the civilian heads told the Committee of Public Accounts that they would tell it what they wanted to tell it.
Cash the Fianna Fáil cheques.
They would tell it what they wanted to tell it and nothing else. With regard to that mantra about not listening to Fianna Fáil, when I was on the Government side of the House, and any of the senior Senators still around and the Minister of State might remember it, I got stuck into the then Minister day and night on health.
The Senator still voted with the Government.
There is a track record, form and consistency here on health.
When did the Senator not vote against any policy? He did not vote against any policy.
That is the scenario there. We have cost overruns in every hospital in the country. We have letters of undertaking being given to Tallaght Hospital for its overdraft. What is going to happen in Sligo General Hospital and Beaumont Hospital with their overruns? We are heading for €500 million so will the Minister have to find €1.25 billion in health cuts when it comes to the budget in December? We have heard his personal view that public sector pay needs to be looked at. Will that be Government policy? Will the Croke Park Agreement be thrown out the window, as it were? The health service as people see it is a farce. We do not have a scenario where, of course, health professionals are working very hard and everyone is doing their best. The bottom line in respect of management is that hospitals are taking out overdrafts, senior civil servants are refusing to answer questions and the Minister is talking about how, aspirationally, we are going to have universal health care, free GP care and the devil and all. However, the reality is that nothing has happened.
Amendment put:
The Seanad divided: Tá, 32; Níl, 11.
Tá
- Bacik, Ivana.
- Barrett, Sean D.
- Bradford, Paul.
- Brennan, Terry.
- Burke, Colm.
- Coghlan, Paul.
- Comiskey, Michael.
- Conway, Martin.
- Crown, John.
- Cummins, Maurice.
- D'Arcy, Jim.
- D'Arcy, Michael.
- Gilroy, John.
- Harte, Jimmy.
- Hayden, Aideen.
- Heffernan, James.
- Henry, Imelda.
- Higgins, Lorraine.
- Keane, Cáit.
- Kelly, John.
- Landy, Denis.
- Moloney, Marie.
- Moran, Mary.
- Mulcahy, Tony.
- Mullen, Rónán.
- Mullins, Michael.
- Noone, Catherine.
- O'Keeffe, Susan.
- O'Neill, Pat.
- Sheahan, Tom.
- Whelan, John.
- Zappone, Katherine.
Níl
- Byrne, Thomas.
- Daly, Mark.
- Leyden, Terry.
- MacSharry, Marc.
- O'Donovan, Denis.
- Ó Clochartaigh, Trevor.
- Ó Domhnaill, Brian.
- Power, Averil.
- Walsh, Jim.
- White, Mary M.
- Wilson, Diarmuid.
Tellers: Tá, Senators Paul Coghlan and Aideen Hayden; Níl, Senators Marc MacSharry and Diarmuid Wilson.
Amendment declared carried.
Due to the failure of Senator Crown to vote "Tá", the amended result is "Tá, 32; Níl, 11".
He did the right thing.
The amendment is declared carried.
Amendment No. 2 not moved.
Question, "That the motion, as amended, be agreed to", put and declared carried.
When is it proposed to sit again?
At 10.30 a.m. tomorrow.