Dáil Éireann díospóireacht -
Tuesday, 18 Nov 2003

Vol. 574 No. 4

Leaders' Questions.

Mr. Kenny

We now have three major reports on reform of the health system – Prospectus, Brennan and Hanly. On 15 October the Minister for Health and Children announced that the Government had endorsed the Hanly report as Government policy and would implement in full its recommendations. Last week the Minister for Defence openly defied the Government's decision not once, not twice but three times, like Peter in the Garden of Gethsemane.

Last week the Taoiseach qualified the Government's support for Hanly with obscure references to geographics and demographics. Last week's Estimates contained an 8% reduction in capital expenditure in the health services. This clearly means that the hospitals in the designated regions cannot expect significant improvements in 2004. Last weekend, following a massive demonstration in Ennis, the Taoiseach committed himself and the Government to consultation with local communities before Hanly is fully implemented, which he suggested would take about ten years.

Communities throughout the country and of whatever persuasion are fearful of services in their local hospitals being removed, downgraded or dismantled. They receive confusing and conflicting messages from the Taoiseach, as leader of the Government, and from members of the Cabinet who support the report in Dublin and oppose it in the country.

It is time we had clarity from the Head of Government on the status of the Hanly report. Is it now Government policy and is it to be implemented in full? How is it to be implemented if there is no money in the Estimates for 2004? Is the Taoiseach not aware that this is causing outrage throughout the country because of the genuine fears and concerns of thousands of people who fear their local service will be removed, dismantled and gone forever? Is the Hanly report Government policy and, if so, how will it be implemented? What is the Taoiseach doing about the comments from members of the Cabinet on the issue?

The Taoiseach

I am glad to say a few words one the issue. I would be glad if, when I say a few words, people would not endeavour to misrepresent them to try to gain political capital in local communities. The Government is willing, as has been stated by the Minister—

Mr. Allen

I cannot hear the Taoiseach.

The Taoiseach

The Government is willing to undertake a radical reform programme for the health service. Having spent considerable time on them, we have now produced three expert reports – Brennan, Prospectus and Hanly. These are comprehensive reports which were researched in recent years. In all of these reports we are putting the patients first so they can receive the right treatment in the right place at the right time. Our commitment to health care is quite clear with increases of almost 200% since 1997. The Hanly report about which Deputy Kenny asked this afternoon will mean a better service for patients. It means a consultant-provided service that harnesses the contribution to all our hospitals enabling a wide range of appropriate services and procedures to be provided in local hospitals. It makes specific recommendations for two regions, for reorganising hospitals on the east coast and in the mid-west, and the reports set out the principles for the national organisation of hospital services. They propose measures to reduce doctors' hours and to improve medical education and training as part of the European working time directive. In pilot areas 300 meetings were held and 600 staff were consulted.

Mr. Sherlock

What about ordinary people?

An Ceann Comhairle

Please allow the Taoiseach to speak without interruption.

Mr. Kenny

Patients will die.

Mr. J. O'Keeffe

Consultation with Fianna Fáil.

The Taoiseach

I have stated time and again that project implementation groups will be set up in the two areas concluded in the model and that groups, individuals, community groups, professional groups will be able to make an input into those two project groups. That is in phase 1. In phase 2, Mr. Hanly and his group are to look at other areas of the country. That work has not commenced yet. It will take place in the future but I do not have the timescale on that. Local groups will also be able to make an input. All of this forms part of the overall health reform agenda for which everybody has been calling because everyone says that we have put in the staff, the resources and the capital programme but we also have to deal with the reform agenda. The hospital service executive group is being set up at present. A senior person and persons to form that group will be announced within days.

An Ceann Comhairle

The Taoiseach's three minutes are up.

Mr. M. Higgins

Thank God for that blessed relief.

The Taoiseach

I will be brief. That group will drive the operation of this whether it be the Hanly, Prospectus or Brennan report. As set out in the report there will also be a hospital services office that will link directly to the Hanly report and there will be the steering group for the overall plan. These are the main elements and groups which will drive the agenda. For people who say that the Hanly report said this or that about different parts of the country, I emphasise that Hanly made his report on two areas. A project implementation group will be set up in those areas. Individuals, groups and communities in those areas will be allowed to report. Hanly has not moved on to stage 2, which is the rest of the country, and I hope that is clear.

Mr. Sherlock

It is a pity the Taoiseach was not in Ennis last week.

Mr. G. Mitchell

It is the banner county.

The Taoiseach

The Tánaiste was there yesterday and she told me all about it.

Mr. Kenny

The problem with the Taoiseach's reply is that one cannot believe anything from the mouth of this Government. There was the Prospectus report, the Brennan report, whose author complained twice about it not being implemented, and now the Hanly report and no money contained in the Estimates, if it is Government policy. I am glad to see that the Minister for Defence, Deputy Michael Smith, is here because he said the people of north Tipperary should not be sacrificed on the altar of Hanly yet he is quite prepared to sacrifice Deputy Hoctor on the altar of Hanly. There is a distinct difference between the view of Deputy Hoctor and those of the Taoiseach and Deputy Michael Smith on this.

When one looks at the unit in Blanchardstown which is not opened, the community care facility in Birr for 90 beds costing €20 million which is not opened, the scandal of Mullingar hospital which is unfinished for the last seven years, one cannot believe what this Government says. If the Taoiseach qualifies the Hanly report by saying consultation in respect of geographics and demographics will take place, does that mean there will be an accident and emergency unit in Nenagh and Ennis hospitals after his Government has implemented the Hanly report? Does it mean that the qualifications of geographics and demographics are going to save the other hospitals around the country? When the people start to march this time they will be unstoppable. The Taoiseach should not take away from people a service to which they have grown accustomed. Given the state of the roads in many areas he should not put that burden or pressure on them or unfortunately tragedy will result. If the Government wants to put its money where its mouth is, let us see in the Estimates where the money will be for the super-regional facilities. The Taoiseach will have left politics in ten years, as he has often said, and Hanly will not have been implemented. Is it a dead duck or not and will geographics and demographics save Nenagh, Ennis and Portiuncula and all the other hospitals? That is what the people want to know.

Deputies

Hear, hear.

Mr. Allen

The Taoiseach should give a straight answer to a straight question.

The Taoiseach

As I have stated, and I thought it was what Deputy Kenny wanted too, because he always says that he wants to see a more efficient—

Mr. Allen

The Taoiseach should answer the question.

An Ceann Comhairle

This is Leaders' Questions. Allow the Taoiseach to speak without interruption.

The Taoiseach

We want to see a more efficient and effective health service around the country.

Mr. English

We are not getting it.

The Taoiseach

We are endeavouring to implement a reform programme. That programme recommends that local hospitals would provide more services, more elective medical, and more surgical procedures, more out-patient services—

Mr. Neville

What about convalescent homes?

The Taoiseach

There will be pre and post-natal services and diagnostic facilities.

Mr. Connolly

More queues.

Mr. Sherlock

There are no facilities in local hospitals.

The Taoiseach

It states that a full range of acute hospital services would be available within each region.

Ms O. Mitchell

Except in Nenagh.

The Taoiseach

Demographics and geographics are important in that context as they were in the spatial strategy and in every other programme so that patients would not have to travel other than for specialised super-regional or national level services.

Mr. Stagg

What about minor injuries?

Mr. J. O'Keeffe

Elastoplast.

Mr. Allen

What about ambulances?

An Ceann Comhairle

Please allow the Taoiseach to conclude without interruption.

The Taoiseach

As the reform agenda states, local hospitals will continue to cater for minor injuries and illnesses and for the high percentage of patients who attend accident and emergency departments. Emergencies will be catered for by well-trained ambulance staff who can provide immediate treatment and bring the patient to the hospital best equipped to provide high-quality care.

Implementation of these proposals is under way. As I have already stated the membership of the expert group to prepare the plan for the national reorganisation of acute hospital services phase 2 will be announced shortly. It has not started. Submissions will be taken from interest groups. The project groups for the east coast and the mid-west are in preparation and will have a special responsibility to take full account of local geographic and demographic factors as the reports state in dealing with and progressing these proposals.

Mr. Rabbitte

I want to raise with the Taoiseach the savage 16 cuts in social welfare announced last week. A senior citizen came into my clinic last Saturday, a man who retired on a modest pension three years ago. He is a coeliac and he explained that his cost of living will increase three and a half times its present level when the dietary allowance is phased out. How can the Taoiseach justify the Minister for Finance taking advantage of the well-intentioned Minister for Social and Family Affairs and cutting her budget for the weakest and most vulnerable in society by €58 million at the same time as he increases the allocation for horse racing to €67 million?

Among the savage 16 cuts are cuts in the housing rental supplement which will literally put people onto the streets; the phasing out of the dietary allowance for people like the man who called to see me on Saturday; the cutting back of unemployment benefit by 11 weeks, even where people have PRSI stamps; the cutting of the back to education allowance for people trying to get a pathway out of their circumstances into third level education; the cutting of the MABS supplement, where the service for people approaching the Money Advice Bureau Service to broker a settlement with creditors is now cut, which will result in those people being driven into the army of moneylenders.

How can the Taoiseach justify cuts of €58 million for the weakest in our society when €67 million will be made available, most of it in prize money, for the diversion of tax exiles in the racing industry? How can the Taoiseach justify the attack on lone parents contained in the cuts of €58 million? How can he justify the situation in community employment in circumstances where we have the most expensive community employment scheme, costing €67 million, for the delectation of those who will not even pay their taxes in this society? I do not include in that €67 million the 100% gift of €15 million arranged by the Punchestown duo, Ministers McCreevy and Walsh, for a facility that we now find is not large enough for the purposes for which it was constructed.

The Taoiseach

The Estimates are before the House today and a number of my colleagues, including the Minister for Social and Family Affairs, Deputy Coughlan, will be going through them in detail. I will say a few words about the Estimates for the Department of Social and Family affairs. The Estimate that will be before the House is one of €10.65 billion, an increase of €355 million over last year. It is almost double what it was just a few years ago, in spite of unemployment figures falling to 4.4%, half the European Union average. This does not take into account increases that will be announced on budget day.

The social welfare spending represents year on year increases under this Government from only a few years ago when the figure was only €7.8 billion. The increases over the period have been largely directed into improving the rates of payment in line with the Government commitments. An estimated 970,000 people on average are expected to claim social welfare payments. The Government has reduced the poverty levels across all areas and categories of social welfare. We have targeted any measures that we have into areas which the Minister will be very glad to deal with. I can go through the back to education allowances, the lone parent allowances and the rent subsidy allowance mentioned by Deputy Rabbitte. There are five measures directed mainly to ensuring that rent supplements are paid in appropriate circumstances in accordance with established policy, taking account of the objectives of the policy—

Mr. Stagg

That is a joke. There is no rent allowance for the first six months. How will people manage for six months?

The Taoiseach

The measures focus, as they are meant to, on meeting immediate and short-term needs, rather than long-term housing needs. In particular we will take into account the interests of vulnerable groups such as homeless, the elderly and people with disabilities.

Mr. Stagg

Who will?

Mr. D. Ahern

We remember the £1.80 allowance.

Mr. Stagg

They will all be out on the streets.

The Taoiseach

They will be fully protected in the course of implementing these measures. Health boards will retain the discretion they currently have to make exceptions in individual cases if the circumstances warrant it. In addition, measures will be implemented in the context of a greater role for local authorities in meeting their long-term needs. The Minister in her schedule and her contribution to the House will give the full details.

Mr. Stagg

What about the diet supplement?

The Taoiseach

The diet supplement mentioned by Deputy Rabbitte is being phased out over a number of years. The supplement has become outdated in the context of real increases in social welfare payments in the past number of years.

Mr. Stagg

The Taoiseach speaks with a forked tongue.

Mr. S. Ryan

The Taoiseach is out of touch.

The Taoiseach

It reduces the necessity for these narrow top-ups. In some cases the diet allowance top-ups are 42 cents per week. I am not too sure what case Deputy Rabbitte is referring to but these are the figures. If he can dispute these figures he may do so with the Minister. They are very small top-ups to the scheme. If a person has an exceptional need, and there is such a case as Deputy Rabbitte mentioned, the person can still put his or her case to community welfare officers.

Mr. Stagg

The Taoiseach should not shift the issue to the community welfare officers.

The Taoiseach

That is what they are there for.

Mr. Stagg

That is most unfair. We know the Taoiseach did not give them the money

The Taoiseach

The social welfare system is not there just to be abused.

Mr. Stagg

The diet supplement is not a means of abuse.

Mr. Allen

The Taoiseach is losing the run of himself.

The Taoiseach

Deputy Stagg will not lecture me because I remember the kind of paltry increases that his party approved. The figure of £2.74 will be remembered, and the tiny increases given by the leader of the party of which Deputy Rabbitte was a then member. We are not going to listen to that. The reality now is that substantial increases are being given across the ranges to the less well off, and in the areas where the Minister has tried to deal with the system and rid it of abuses which should not be there, she has allowed for measures to assist people in need.

Mr. Stagg

What about the money for the horses?

The Taoiseach

The issue of the money for horses is that in Deputy Stagg's constituency most of the money—

Mr. Stagg

The money was taken out of single parents' allowances.

The Taoiseach

If the Deputy is against the 25,000 people involved in that industry, mainly people in the Deputy's constituency—

Mr. Stagg

Rubbish. There are not 25,000 people involved.

An Ceann Comhairle

Deputy Stagg is not entitled to ask a question. We are dealing with Leaders' Questions.

The Taoiseach

Deputy Stagg has stated quite clearly that he believes all the people in the racing industry should lost their jobs. That is what he has stated and now we know what his policy is in Kildare.

Mr. Rabbitte

I hope the Taoiseach is not suggesting that the dietary allowance is a means of abuse. The gentleman I mentioned, who is 67 or 68 years old, explained to me that it is not just bread and the essentials of life he has to order from his chemist, but even cornflakes. He tells me the cost per week will be three and a half times what it was.

Taking another example, a person must rent for six months before getting the rent allowance. How does the Taoiseach propose that people who are destitute, who cannot get public housing, can rent from one of his Fianna Fáil-supporting landlords in 2003, and find a deposit? How will they do that? If, when such people go to the community welfare officer, their parents have paid their rent for the first six months, and not many are in those circumstances, the officer will say that if the person had means for the first six months, then under the rules and guidelines that person has means for the next six months.

So it goes on, right through the 16 cuts. The Minister for Social and Family Affairs was taken advantage of by a Minister who himself became famous for the dirty dozen cuts, the same Minister who makes an annual grant to the horse racing industry that is now worth €40 for every visit by a punter to a race meeting in Ireland.

An Ceann Comhairle

Deputy Rabbitte—

Mr. Rabbitte

The Ceann Comhairle did not interrupt the Taoiseach and let him run for a long time.

An Ceann Comhairle

The Chair pointed out to the Taoiseach that his time was up.

Mr. Rabbitte

Yes, the Chair did so. If the GAA were to get €40 for the four million people who attend its games annually, it would be getting a grant of €160 million per annum. It is the richest tax exiles who play with the prize money that is put through the hypothecated 2% betting tax. That comes to €67 million, and the Taoiseach forced the Minister for Social and Family Affairs to cut €58 million from the most vulnerable in our society, people who have no voice, who in the main do not vote, without whose votes the Taoiseach has decided he can get re-elected. It is a disgrace and a shame and it will long run in this House until he re-thinks it.

The Taoiseach

I said that the diet supplement is being phased out over a number of years. I did not say it was abolished. I said that the small top-ups are as low as 42 cent. I also stated that if a person has a case, it is still at the discretion of the community welfare officer to decide. In relation to the rent supplement measures, I stated that there were five measures to ensure that rent supplements are paid in appropriate circumstances in accordance with established policy and taking account of the objectives of the SWA scheme, which will focus on meeting immediate short-term rather than long-term housing needs. The health boards will retain the discretion they currently have to make exceptions in individual cases if the circumstances warrant it.

I also stated that 970,000 people are expected to claim social welfare payments under the headings of child benefit, old age contributory pension, widowed person's pension, disability allowance and supplementary welfare allowance. Significant increases have been made in those areas. The Minister has provided €10.5 billion and has put forward proposals to ensure more focused methods. She has allowed a means where those with a genuine case can appeal a decision in a fair manner—

Mr. S. Ryan

The Taoiseach set up the Minister.

The Taoiseach

—rather than abuse of the system which is happening in some areas.

Mr. Sargent

Today we now understand what the Taoiseach means when he says that a Minister totally, totally supports Government policy. It seems "totally, totally" is the Government's equivalent of double yellow lines in traffic law, meaning very little until a few offenders are clamped. Will the Taoiseach say who it is he totally, totally supports on the issue of including waste incinerators in the national infrastructure bill?

In The Irish Times last Saturday, it was reported that Ministers are at odds over fast-track planning, “McDowell and Cullen on collision course over proposals to include waste incinerators in new legislation”. The Taoiseach unveiled at a Fianna Fáil Ard Fheis the idea of a fast-track planning system to further remove accountability in the planning process. This comes on top of the removal of powers from councillors to decide on matters of infrastructure and the imposition of prohibitive charges for submissions by ordinary people in the course of planning applications and appeals. Will the Taoiseach tell the House, the Minister, Deputy McDowell, the Tánaiste – who I am sure would like to be informed – and the Progressive Democrats if incineration is to be part of the new Bill to be unveiled before Christmas? The Progressive Democrats view on this issue was delivered quite emotionally last Thursday at a meeting in Sandymount by the Minister for Justice, Equality and Law Reform. It would be appreciated if the Taoiseach could give the House the Fianna Fáil view and clear the matter up.

The Taoiseach

As I stated recently, the legislation on infrastructure which aims to move some major national projects forward is under discussion in the Department of the Environment, Heritage and Local Government. It will be brought to Cabinet in due course. I am pleased to inform the Deputy that the office of environmental enforcement within the EPA is working to secure enforcement of environmental legislation and to provide better resources for local authority environmental enforcement. This is working very well. The delivery of necessary waste infrastructure is being speeded up at regional level and is progressing well. The establishment of new structures to provide waste prevention, minimising and recycling and to promote the development of markets for recyclable material is progressing very well. New producer responsibility initiatives are being introduced for end-of-life vehicles, tyres, electrical equipment and construction demolition waste and this is progressing very well. It is hoped to publish a national biodegradable waste strategy in 2003. I thank the Deputy for his support in all those areas.

Mr. Sargent

The Taoiseach will forgive us for not taking his reply very seriously, given that the Estimates provide for a 32% cut in EPA funding. It is difficult to foresee how the EPA will undertake those projects.

I am aware that the Taoiseach consults widely before taking any decisions, if he takes any action at all. We witnessed the case of the great survivor, the Minister for Defence, Deputy Michael Smith, who is smiling in his seat beside the Taoiseach.

Mr. McCormack

He is the great warrior.

A Deputy

The old war horse.

Mr. Sargent

Has the Taoiseach discussed with the Minister, Deputy McDowell, and the Progressive Democrats in Galway West, for example, the prospect of locating a mass burn incinerator? That seems to be the issue which is upsetting the Progressive Democrats, understandably so.

Mr. McCormack

No, it is not.

Mr. Sargent

Both Government parties have a stated policy, that Fianna Fáil and the Progressive Democrats believe mass burn incineration of unsegregated waste with no energy recovery is not an acceptable practice today. The Minister, Deputy McDowell, became very upset last Thursday at the public meeting and told my colleague, Deputy Gormley, and many others that the Ringsend incinerator is contrary to Government policy. Will the Taoiseach therefore assure the House that the proposal for incineration as proposed in Ringsend and in other sites around the country is effectively dead in the water, given that forensic analysis by the Minister for Justice, Equality and Law Reform? Will the Taoiseach say whether the proposal for mass incineration or the Minister is dead in the water?

Mr. McCormack

It is the Minister for the Environment, Heritage and Local Government.

The Taoiseach

I believe Deputy Sargent has listened at length to the Minister, Deputy Cullen. He outlined Government policy a few weeks ago.

Mr. Gormley

What policy?

The Taoiseach

The only policy there is.

Mr. Gormley

What is the policy?

An Ceann Comhairle

The Deputy's leader is entitled to the courtesy of hearing the Taoiseach's answer.

Mr. M. Higgins

We would all like to hear it.

The Taoiseach

The policy has been clearly stated. I hope that the various infrastructural schemes will receive—

Mr. McCormack

All of them?

The Taoiseach

There are approximately four major ones and they will receive support. There are some people who would prefer if local people did not make their views known to Ministers or politicians but they are entitled to do that and Ministers listen to these views. I do not know what the philosophy of the Green Party is on anything.

Mr. D. Ahern

They are serial objectors.

The Taoiseach

I know its members are against everything. When Members have concerns about trucks coming through their area and they want to hear what is being proposed for the treatment of environmental waste, they are entitled to listen to those views. The Minister, Deputy Cullen, has clearly stated the Government position on these issues. The infrastructural Bill, which is not related, will be brought before the House in due course.

Mr. Boyle

The Minister for Justice, Equality and Law Reform.