Dáil Éireann díospóireacht -
Wednesday, 6 Oct 2004

Vol. 589 No. 4

Leaders’ Questions.

Mr. Kenny

Next Sunday, 10 October, marks World Mental Health Day. This Government has very little to be proud of in that regard. The statistics regarding mental health in this country are truly frightening. Over 300,000 people suffer from depression. One in every nine people has or has had some form of mental illness. The Irish College of Psychiatrists said that one in four people will be affected by mental illness at some time during their lives. A study commissioned by Mental Health Ireland and conducted by pollsters found that three quarters of the population know someone close to them who has or has had mental illness at some time during their lives, mostly depression. As the Taoiseach is well aware, Ireland has the highest rate of suicide among young men in Europe. It is perverse that while suicide rates in Ireland rank at over 450 per year, more than tragic motor accidents, the Government has refused and so far failed utterly to implement the Report of the National Task Force on Suicide.

What is the Government's strategy to deal with mental health, now that the Fianna Fáil members of the Government at least have a new understanding of social inclusiveness and what it means to have a caring society? What are the Taoiseach's targets for budgetary expenditure on mental health this year? He is aware that in 1997, 11% of the total health budget went towards mental health. It is down to 6.6% in 2003, despite the fact that the World Health Organisation made a general recommendation that it should be of the order of 14%. What does the Taoiseach propose to do about that this year, in view of the fact that the Minister for Finance has a bulging bag of money to dispense?

The Taoiseach

The Government is committed to developing a high quality, community based mental health service and we provided significant additional resources to achieve that. It has been the view since the mid-1980s that we should try to move from old mental health institutions to providing a far better community based service where back-up staff would be available, both psychiatrists and psychologists, care workers and care nurses, who would be actively engaged in the community in trying to move people from the old large institutions into the community where they could live in collective housing. That has been the policy for the best part of 20 years and it continues to move on.

Deputy Kenny asked what we are doing currently. In excess of €90 million in additional revenue has been invested in mental health over the past few years to build on that service. The Deputy also asked about the total mental health budget. It is now €661 million, which is a considerable expenditure. On the capital side, new acute psychiatric units have opened recently in both Kilkenny and Castlebar, bringing the total number of such units in the State to 21. We recently allocated €10.7 million to James Connolly Memorial Hospital to fully commission the new units, including the 56 bed acute psychiatric unit. While acknowledging that a delay occurred in that project it is now moving ahead at full speed, and this will help in the mental health area. We have also provided resources for the recently opened 50 bed acute psychiatric hospital in Portlaoise General Hospital.

On the general front, the Mental Health Commission was established two years ago to foster high standards and good practices in the delivery of mental health services and to ensure the interests of people who have been detained are protected. As Members of the House will be aware, that is also an important issue. The Expert Group on Mental Health Policy has commenced work on the preparation of a new national policy framework for the future development of mental health services to which the Government is committed.

We have a new inspector of mental health services who has replaced the former Office of the Inspector of Mental Hospitals, something which had created much difficulty in the area over the years. That person was appointed by the Mental Health Commission. The new inspector is required to visit and inspect approved centres at least once a year, preferably more often.

I agree with what Deputy Kenny said about the rate of suicides here, particularly among males. It is exceptionally high but both the Department and the agencies have long undertaken research to determine what we and the agencies can do collectively to assist people, which they are trying to do.

Mr. Kenny

I will tell the Taoiseach some measures he can take. In his reply the Taoiseach indicated some of the targets set out in a 1984 report on mental health, many of which still have not been achieved. He spoke about allocating €90 million for mental health services since 1997, yet persons sitting beside the Taoiseach allocated €50 million in one year for electronic voting, the machines for which lie in storage throughout the country.

Mr. McCormack

Costing a great deal of money.

Mr. Kenny

Yesterday, the newspapers reported that 80% of those on tranquillisers in Ballymun had been on them for over 12 months when medical recommendations are that persons should not be using them for more than two weeks.

I want to ask the Taoiseach about four measures he says he will take. First, will he set up a ministerial task force at Cabinet level to tackle mental health and bring it to a summit, such as happened with regard to traffic business some weeks ago? Second, will he set up a dedicated psychiatric service for 16 to 18 year olds? Will the Taoiseach confirm that nobody with an intellectual disability will be left any longer in a psychiatric institution? Will he ensure the report of the task force on mental health is implemented, and set target dates for it to be finalised?

The Taoiseach

The Department of Health and Children is either dealing with, or is involved in, these matters.

Mr. Crawford

Or it is not dealing with them.

The Taoiseach

The Mental Health Commission was set up two years ago on the principle of providing and fostering far higher standards and good practices in the delivery of mental health services, and to ensure the interests of people detained are protected. The Government is committed to doing that. The new inspector of mental health services has replaced the Office of the Inspector of Mental Hospitals and is required to visit and be aware of the circumstances of people detained in hospitals and of anyone held against his or her will or in an unfair and unreasonable fashion. The Government is committed to providing resources. We gave €90 million in 1997 and every year since then have continued to increase the base figure bringing it to €660 million today.

Deputy Kenny referred to the 1984 report which set a blueprint for changing what had been happening since the 1870s in mental health services, and for moving away from institution-based confinement areas to place people in the community. Since then the Department of Health and Children and the mental health sector have moved on those proposals to provide acute beds in hospitals for mental health patients and for those who do not require to be in hospital, to provide a strong community base with very good services whereby people are visited daily.

Mr. Allen

That is not true.

The Taoiseach

Those units in the various health board areas have changed the lives of people with mental health problems. We are committed to continuing to enhance that service.

Mr. Rabbitte

For a number of years tens of thousands of people on very low incomes and sometimes in considerable pain and suffering cannot get a medical card. The Taoiseach knows this from his constituency work, his backbenchers and the research he conducted prior to the general election. That is why he promised 200,000 additional medical cards.

My colleague, Deputy McManus, has received a reply from the Minister for Health and Children on the progress made in this area which shows that 101,279 cards have been taken out of the system. If the Taoiseach thought that he ought solemnly to pledge an additional 200,000 in May 2002 and the performance since is to take out 101,000 I need not explain how grave that situation is. People on the minimum wage, earning €7 per hour for a 40-hour week, make €280 yet a single person earning above €143 cannot get a medical card. A couple with two children earning more than €259 cannot get a medical card.

How can this Government justify that situation? How could it have the hard neck to bring Fr. Seán Healy to Inchydoney and profess compassion and caring in circumstances where a parent on that kind of income woken by a sick child at night decides whether to visit the doctor on the basis of ability to pay rather than the health of the child? A visit to a GP costs between €35 and €50. Can the Taoiseach imagine being required to pay that out of such paltry pay before paying for a prescription or being subjected to all the other increases in the cost of living? How can the Taoiseach say that is justifiable in this extremely affluent economy?

The Taoiseach

The Government is not saying it is justifiable that people on the minimum wage have the difficulty outlined by the Deputy. We made a commitment to extend admissibility for medical cards.

Mr. McCormack

It has forgotten about it.

The Taoiseach

The Government will try to fulfil that commitment.

Mr. McCormack

Deputy Harney will fix it.

The Taoiseach

Do the Deputies want to hear the answer?

Ms Burton

We are waiting for an apology.

Mr. J. O’Keeffe

By their fruits shall you know them.

The Taoiseach

Deputy Rabbitte would acknowledge that 1.1 million people have medical cards. That is 30% of the entire population. One of the successes of recent years is that incomes have been rising fast. In any system of means testing some people will pass eligibility limits because incomes are rising substantially in many areas. Take home pay for average industrial wage earners has risen by 80% in recent years. This Government has introduced a minimum wage which is the highest in Europe. Income guidelines are revised annually in line with the consumer price index and the Tánaiste and I have recently reiterated the commitment and are examining the extension of eligibility for medical cards.

It is a costly area and we must consider how best to target it. We will direct it at those people whom Deputy Rabbitte highlighted, those who are most in need, to ensure those who have children and still do not have jobs, or who have difficulties, receive the card, so most of those without jobs will be part of the 30%. There are people on the minimum wage of €273 per week who may have two children and are caught. I am very well aware of that. In our examination of it as part of the Estimates process we have already highlighted this area.

Mr. J. O’Keeffe

The Taoiseach must keep on wriggling.

Mr. Rabbitte

The actual figure is 27.7% and if one adds those aged over 70 it comes to 29%. It was intended that cards for those over 70 would cost €19 million but it cost €59 million when the Government introduced cards irrespective of means for that age group. One third of people at work are not liable for income tax because they earn less than 90% of the minimum wage. How can the Taoiseach talk about rising incomes when there is a serious problem of low pay in this economy? There is a belt of people denied a medical card because they receive social welfare payments or whatever. Hard working, tax compliant people in pain are afraid to go to the doctor because they cannot pay for the service. That is the short and the tall of the matter. I am surprised the Taoiseach has attempted to defend the indefensible. These are paltry income thresholds above which one will not get a medical card. In addition, the figures show that the discretionary facility that existed for years has effectively been removed in most counties. I, and I am sure every other Deputy, has chronic cases of people in exceptional circumstances who would normally have got a medical card on a discretionary basis but do not receive one now. I do not know what the Minister of State at the Department of Community, Rural and Gaeltacht Affairs, Deputy Noel Ahern, is talking about.

Mr. N. Ahern

I know the facts but Deputy Rabbitte does not seem to know them.

Mr. Rabbitte

He sees in his clinics, as I do in mine, that there are people on paltry incomes who are ineligible for a medical card.

Mr. Deasy

They have had them taken away.

Mr. Rabbitte

There is no gainsaying that 100,000 have been taken out of the system. In addition to the 200,000 extra cards promised by the Government, that makes 300,000 to make up in order to fulfil its pledge to the people in 2002. I cannot see how the Taoiseach can argue with that.

Mr. J. O’Keeffe

Deputy Noel Ahern's brother has no defence in respect of this matter.

The Taoiseach

I do not know which figure Deputy Rabbitte is using to support his argument. There are 1.1 million people with medical cards. I have already accepted that we must extend eligibility. We have the highest number ever of people in employment. When 1 million people were working, obviously there were a higher number of medical cards. There are now——

Mr. Ring

The Taoiseach should refer to the guidelines.

An Ceann Comhairle

The Taoiseach should be allowed to continue without interruption.

The Taoiseach

——1.94 million people in the labour force. We have one of the lowest unemployment rates in Europe.

Ms Burton

The cost of visiting a GP is one of the highest in Europe.

An Ceann Comhairle

These are Leaders' Questions. Deputy Burton is not the Leader of her party.

The Taoiseach

Of course there were more medical cards when almost 20% of people were unemployed and when the country was on its bended knees. The Government accepts that some people currently find themselves in a difficult position. We are trying to see how best to deal with the matter. I am merely making the point that extending eligibility is costly.

Ms McManus

It is not. It offers very good value for money.

The Taoiseach

As Deputy Rabbitte pointed out, when we gave medical cards to the over-70s — everyone did not agree with this action but we believed it was a fair and reasonable thing to do — the cost was far higher than projected. We are not making any apology for giving medical cards to people in their later years.

(Interruptions).

An Ceann Comhairle

Allow the Taoiseach to conclude without interruption.

The Taoiseach

We will also try to help people in other categories. We will extend eligibility in so far as is possible.

Mr. J. Higgins

Why has the Government not dismissed the chief executive, the chief financial officer and the chief operations officer of Aer Lingus in the wake of the stunning conflict of interest in which they placed themselves in seeking the privatisation of the national airline so that they could purchase it themselves and, in the process, make an obscene financial killing? Have neo-liberal capitalist values so saturated the Government that it sees no difficulty with Aer Lingus executives, charged with protecting a crucial asset of the taxpayer, sitting in their offices and plotting how they can make it their private property? To facilitate that plot, they are intent on stripping the asset of 1,300 jobs and key core activities to make it more attractive for venture capitalists whom they want to purchase it. Does the Taoiseach agree that in any other jurisdiction, where even the loosest norms of even bourgeois ethics apply, such an outrageous conflict of interest would be dealt with by instant dismissal?

Was the Taoiseach amazed, perhaps he was gratified, that during the summer entire swathes of the media devoted acres to engaging in idle and useless speculation about his intended Cabinet reshuffle — which eventually amounted to no more than a hill of beans — and scarcely passed comment on this breathtaking conflict of interest in our national airline? Am I missing something, or is there a credibility chasm between media condemnation this morning about a number of €9,000 watches presented to departing Aer Rianta board members at public expense — the Taoiseach correctly stated yesterday that this is inappropriate and even a spokesperson for the Progressive Democrats engaged in sanctimonious condemnation of this action — and the deafening silence about a critical strategic public asset, our national airline which is worth €500 million, being speculated with by those charged with its protection and the protection of the taxpayer? Fianna Fáil and Progressive Democrats members of Cabinet appear to have no problem with this conflict of interest. Will the Taoiseach explain how this is the case?

The Taoiseach

I will answer the questions on Aer Lingus. Throughout his contribution, the Deputy confused that company with Aer Rianta. I am aware that he does not represent that area of the city and probably does not realise that they are two separate State companies.

Mr. Ring

Will the Taoiseach give the Deputy a watch?

Mr. C. Lenihan

Deputy Joe Higgins needs a compass not a watch.

The Taoiseach

The Government has not attempted to remove any of the individuals to whom the Deputy referred because they have worked with the trade unions and the staff to try to get Aer Lingus out of the difficult position in which it found itself. They have been successful in doing so in recent years. There are only two airlines in the world, and in Europe in particular, which are making money and both are Irish, namely, Aer Lingus and Ryanair. The staff of Aer Lingus has worked hard in that regard. Alitalia, Sabena and all of the other airlines are gone, going or are drastically cutting back on their operations. Only the airlines in this country are making profits. I give credit for that obviously to the management but mainly to the staff of Aer Lingus who have turned the position around into one of profit.

Mr. Willie Walsh will today outline to a committee of the House the difficulties facing the aviation business. These are immense, particularly as a result of the escalation of oil prices in the past year. This escalation has placed huge pressures on the cost-base of airlines because an enormous proportion of their cost structures are based on fuel. The astronomical increases, which have been much greater than anything predicted by economists — not to mention the airlines — have placed pressure on the company. Mr. Willie Walsh and his staff and, by extension, the Department and the Government are trying to work through these difficult times in international aviation. The company has been doing so in conjunction with the staff. It has meant pain for some staff due to reductions in the workforce. In far larger countries, however, it has not stopped at small or considerable losses of jobs, entire airlines have gone to the wall. The trade unions, management and staff have tried to retain the greatest number of jobs and, in addition, to expand and not reduce the business in these difficult times. Aer Lingus has sought new markets and routes in Europe. These developments are commendable and require our support in order that the company can try to overcome any problems. However, the international position remains difficult.

If Deputy Joe Higgins believes that Aer Lingus, a relatively small airline from an island country, can stand up against what has happened in the international market in recent years, he confirms what I have always believed, namely, that he lives in cloud cuckoo land. It is not possible to do that. We must try to deal with this situation as best we can and both the management and the unions are doing that.

Mr. Healy

What about the conflict of interest? The Taoiseach should answer the question.

Mr. J. Higgins

The Taoiseach is not hanging out with a soft-soaping Hector today, when any old answer might do. I inquired about a conflict of interest and the Taoiseach did not provide a reply. He accused me of confusing Aer Lingus with Aer Rianta. Admittedly, some members of the Cabinet have difficulty knowing where they were. When he was sent to the Department of Health and Children, the new Minister for Finance thought he was in Angola. I did not confuse the two. If a private company making a loss closed with 200 jobs lost, the air would be thick with gloom and the creation of task forces would be mooted. However, a publicly owned company that will make a profit of €90 million this year is proposing to savage 1,300 jobs and the political establishment and most of the media have not raised even a murmur. Is the Taoiseach aware that there is a callous and concerted strategy on the part of management at Aer Lingus to undermine and demoralise the company's employees in many areas of its operations such as reservations, telesales and baggage handling by outsourcing their work and making life impossible for them in order that they will walk the plank and feel they have no option but to accept redundancy? This is all aimed at stripping down the airline so that speculators will move in and buy it and the management, charged with protecting the interests of taxpayers, will make millions in the process. Is there a conflict of interest?

The Taoiseach

The redundancies are regrettable but they are voluntary.

Mr. Healy

Is there a conflict of interest?

The Taoiseach

People have to——

Mr. J. Higgins

They are not voluntary. Decent workers in Aer Lingus are being hounded out of their jobs. That is the reality.

An Ceann Comhairle

Deputy Higgins should allow the Taoiseach to reply without interruption.

Mr. Rabbitte

Is there a conflict?

Mr. J. Higgins

Is there a conflict of interest? That is the question.

An Ceann Comhairle

The Taoiseach is entitled to the courtesy Deputy Higgins was afforded, to be heard without interruption. I ask the Deputy to resume his seat.

Mr. J. Higgins

I am entitled to the courtesy of an answer.

The Taoiseach

Yesterday I stated that I did not believe a management buy-out was appropriate in the situation of Aer Lingus. I do not think that is a solution. While Aer Lingus has difficulties and aviation is having enormous difficulties there are now restrictions on investing capital. While in 1993 the State could give significant state aid, we cannot do that anymore. So the company——

Mr. Quinn

That is not true.

Mr. Stagg

The Government can.

An Ceann Comhairle

This is Deputy Joe Higgins's question.

The Taoiseach

It is absolutely true. There is no possibility, as has been the case with Sabena and Alitalia in other countries, of the State investing under the old regime.

Mr. Quinn

If venture capitalists can invest the State can.

The Taoiseach

Deputy Quinn is talking about a different issue now.

An Ceann Comhairle

This is not Deputy Quinn's question.

The Taoiseach

We cannot give State aid. I do not believe it is compatible with the mandate of Aer Lingus to have a management buy-out.

Mr. Healy

Why is the management proposal still there?

The Taoiseach

We want to have a strong Aer Lingus in the future, which is what it is achieving. It is the only aviation company in the State sector, along with the one in the private sector I mentioned earlier, that is managing to turn things around. Yesterday Alitalia announced a workforce reduction of 3,000 and is in considerable difficulty of going under altogether. We are trying to avoid that. Deputies should not propose simple solutions suggesting that the aviation industry can act differently from aviation in Australia, Canada, America or anywhere else in Europe. They should not try to feed that kind of nonsense to people.

Mr. Healy

Is there a conflict of interest?