Leaders’ Questions.

Yesterday, I spent some time at the hospital bedside of a man I know well who is dying of cancer. His wife sat there holding his hand as the end approaches. Many Members will have had this experience with a family member, an acquaintance or a friend.

Today's report of the National Cancer Registry dealing with the discrepancies in cancer treatment throughout the State makes one realise the lottery for life with which people must contend. It very much depends on where one lives. The report indicated that women suffering from breast cancer have a 30% higher chance of dying if they live in the west and the midlands than if they live in Dublin. Men with prostate cancer are twice as likely to die within five years if they live in the mid-west than if they live in the east.

One cannot even get a hospital bed in the west.

If I want Deputy Cowley's assistance, I will call upon him. The appalling discrepancies in cancer treatment are an indictment of the Government's programme to provide a world class health service. The varying rates of survival, indicated in the report, will frighten many. The survival rates for breast cancer in the north east stand at 72.3%, 73% in the mid-west and 73.5% in the south east. Surgical services are widely unavailable in the regions while the availability of chemotherapy and radiotherapy leaves much to be desired.

The Deputy's time has concluded.

Does the Taoiseach have any idea why chemotherapy is likely to be used in three times as many cases in the west for prostate cancer as it is in the east? In January of this year we learnt that the national plan for radiation oncology services, announced by the Government in 2005, was completely hollow and shallow because it had not been thought out by the Government in this first instance. We should remember that the targets set out in that plan were described by senior officials of the HSE, responsible for the programme as not being achievable. Does this not make a mockery of the Government's strategy for a world class health service in the area of cancer treatment services? The issues identified by those officials indicates that the plan was not thought out and that the words of the Government in respect of it were hollow. While cancer can strike any person, it is difficult when people such as the couple I spoke to yesterday say "Why has the Government let us down in this region in terms of the availability of services?" Arising from this report, does the Taoiseach believe it is right or fair that a person's address indicates the place in his or her lottery for life as a result of the Government's inadequacy in the provision of cancer services?

I welcome the publication of the report by the National Cancer Registry on survival patterns of care. The report cover the period up to 2001, some six years ago. It shows improvements in survival rates for breast, colorectal and prostate cancers but not for lung cancer at national level during that time. It shows improvements in all regions for breast and prostate cancers and in most regions for colorectal and lung cancers. There is no doubt that there are regional disparities in cancer survival rates. The cancer strategy published last year, which was welcomed by all the stakeholders, is designed fundamentally to change that. One of the major objectives of that strategy is to improve the outcomes for cancer patients in every region.

How can the position improve when people have to wait——

Allow the Taoiseach to reply to Deputy Kenny's question.

We are funding and organising cancer services to ensure that patients from every region will be benefit equally from top quality cancer care. Using more specialised care in the major centres is the way to achieve this. That is what all the experts indicate and all the evidence shows that. It is vital that cancer specialists treat a sufficient number of cases to maintain and grow their skills. That has been pointed out in a number of reports published during the last six or seven years.

We are again this year making a large allocation available for cancer control, screening, acute services and research. The increase in investment this year is almost three quarters more than the comparable investment for the previous year to support the implementation of the national cancer control programme.

The HSE and the Department of Health and Children are also working on the means to implement the national plan for radiation oncology services to meet the timeframe. The Deputy will be aware that the timeframe for the rolling out of that programme nationwide is another four years. The Deputy raised this issue with me previously. It is considered by all the people involved in the programme that it will not be rolled out any faster than that. It will take until some time in 2011 to roll out radiation oncology services on a national basis.

I am sure the Taoiseach is aware from his discussions on this area that early detection and early intervention save lives. When I was in Tralee recently the consultants I met made it perfectly clear that people die in that region because they are waiting for endoscopies and analysis — they die. Why have mobile screening units not been provided throughout the west and north west? There was no waiting list in Sligo General Hospital last week and a great service is available in that hospital. However, many women may well have much shorter lives than they expect because they may have breast cancer but have not been screened. Mobile screening units should have been made available throughout the country to provide such early analysis but that is not the case.

Why is chemotherapy used three times more often for the treatment of prostate cancer on men in the west than in the east where surgical treatment applies? What is the reason for that if there is supposed to be a national standard? Can the Taoiseach explain that? Deputy Twomey published a document on this issue in 2004 in which Fine Gael proposed a screening test for every man and woman for the detection of early signs of these problems. Does the Taoiseach accept that would be a vital and essential service?

I note in his sprint on Saturday, the Taoiseach outlined, in breathtaking fashion, his proposal for free screening for breast cancer, cervical cancer and prostate cancer.

The Deputy's time has concluded.

What does that mean? Following last Saturday night's exclamations, when will those services be rolled out? Does the Taoiseach believe this report, which clearly indicates that mortality in Ireland in 2007 is directly related to where one lives, is indicative of the world class health service he and his Government promised in view of the glaring discrepancies in treatment for those who require chemotherapy, radiotherapy and so on? What are the Taoiseach's comments in response to those questions?

As I said, last year there was a 75% increase in staff resources. That investment was to support implementation of the Health Service Executive national cancer control programme. It was for screening and acute services but men, in particular, and Deputy Kenny has been talking to some cancer consultants, are slower to come forward for screening programmes. It is only through active screening programmes for prostate cancer that we will have success in the fight against prostate cancer. That is the reason we invested those resources.

This report covers the period from 1994 to 2001 but as a society we invested €1 billion in cancer services nationally in the past few years. That is a significant level of resources and it has been invested substantially in all regions to improve cancer survival rates.

Deputy Kenny mentioned Sligo. He will be aware that some of the best consultants are located in the west and operate from a Galway base. Many of them trained abroad but now work in the west because that is from where they hail. One hundred additional consultants have been appointed in the key areas of medical oncology, radiology, palliative care, histopathology and haematology. If the Government can complete the contract with the hospital consultants, we will move quickly to employ several hundred more consultants, including in the area of the national cancer services. We have employed 245 clinical nurse specialists who have also been appointed in the cancer services area. Nearly 94,000 inpatients and day patients were discharged from hospitals following a diagnosis of cancer, an increase of nearly 70% on the figure ten years ago.

I regret that people continue to die from cancer, including friends of Deputy Kenny, but there has been an enormous improvement in the cancer services that have been rolled out — over 70% in terms of patients discharged compared to the number of patients discharged in 1997. This year we set up the National Cancer Screening Service Board. That amalgamates BreastCheck, which was established by the then Minister for Health, Deputy Martin, in 1998 and the Irish cervical screening programme, both of which are now part of the national screening programme. Both BreastCheck and the national cancer screening programme are being rolled out nationally this year.

It took a good while.

That new service alone has been allocated €33 million which is an increase of more than 70% over last year. That service will also advise on the implementation of the national colorectal screening programme.

What about the mobile units?

It is possible to use mobile units but treatments such as radiation oncology are best carried out in national hospitals and some private hospitals, which also provide the treatment. The mobile centres are not very expensive, but the main accelerators cost several million euro. These are based in the hospitals as are the other back-up services such as medical oncology and the consultants in radiology, histology and haematology. To be successful they need to have experience of dealing with a large number of cases. The mobile clinics are used for screening purposes only and patients must be referred to hospital centres. Resources are used to build up national centres of excellence that can deal with a critical mass of patients. I acknowledge that our success rate is not at the level of the rates in the United States where screening is continually undertaken, but our rate has improved dramatically in the past decade.

I wish to raise the topic of Deputy Brennan, Minister for Social and Family Affairs. Does anyone on the other side of the House know his whereabouts and how he is? The Taoiseach sent him out last Tuesday to present a press conference about the coming Ard-Fheis and the man was but a pale shadow of himself, so shocked was he at the policy platform put forward by this side of the House. The man was aghast at what modest proposals from this side of the House would do to the country. He stated:

We will certainly not be matching the unprecedented scale of the promises given by Fine Gael and Labour. We will promise less because our approach will deliver more.

You have all been conned.

They could hear the polls talking then.

Then looking into the camera, as only the Minister, Deputy Brennan, can do, with all that sincerity, he described himself as "alarmed" at what was happening on this side of the House.

Deputy Mulcahy is also absent. He said: "I urge the Taoiseach to stand firm; no tax cuts and no more spending to put the economy at risk". I saw Deputy Mulcahy on the screen before my eyes on Saturday night, applauding like Mr. Bean on speed. I wish to ask the Taoiseach about the impact on the Minister, Deputy Brennan, of the Niagara of promises the Taoiseach unleashed on his unsuspecting Cabinet on Saturday night. There were 53 different commitments, amounting to €300 million per minute. We are fortunate the Taoiseach only had half an hour. What would be the position if he had a full hour?

The Minister for Finance, in more sober terms, also espoused the prudence agenda. He stated that our economic success has not been built on trade alone, that responsible economics, prioritising budgetary balance and debt reduction provide the foundation for our current prosperity. He said that is why Fianna Fáil's proposals for the next five years will be fully costed, fully detailed and fully affordable. Will the Taoiseach say what is the full cost? The Opposition and the people will judge whether they are affordable. What happened the prudence and why did the Taoiseach reverse engines mid-week and take his unsuspecting Ministers by surprise? Why did he promise 2,000 additional gardaí when the hapless Tánaiste and Minister for Justice, Equality and Law Reform is in here every day of the week saying there are enough gardaí, that he is happy with the situation and things are under control? What happened prudence the day the music died, on 24 March 2007?

It seems to have affected Deputy Rabbitte greatly.

Affected me — I had the best craic of my life.

I am very touched by the manner in which Deputy Rabbitte——

The Taoiseach must be touched to announce a package like that.

——is concerned about the Minister, Deputy Brennan.

Anybody who is sane would not do so.

The Taoiseach, without interruption.

The Taoiseach must be touched.

I am delighted to know Deputy Rabbitte is so concerned about the Minister, Deputy Brennan, and I will pass on his regards in person.

Was the Minister traumatised at the Ard-Fheis?

What ward is he in?

I thank Deputy Rabbitte for upsetting his usual family and social occasion on Saturday night by staying in to watch me on television. I appreciate that greatly. I read a few weeks ago that one of his undercover agents had discovered that Fianna Fáil was about to cut the tax rate to 18% and that is why Deputy Rabbitte changed the habit of a lifetime from his old days with the Workers' Party and Democratic Left and all his other parties, to go for a new agenda and to propose tax reform.

We declared that, If the economy remains strong, we will cut taxes. As we have done for 20 years, we will continue to reform the taxation system and reduce tax rates, as we have done. We have introduced every single tax reduction, bar the 1% reduction which Deputy Quinn achieved when he was Minister for Finance. We will continue to reduce the higher rate of tax to 40% and we will complete the reform of PRSI by abolishing the ceiling whereby no PRSI is paid on incomes over €49,000. We will halve the full rate of PRSI from 4% to 2%, we will cut the self-employed PRSI rate and will double the home care tax credit. As the Tánaiste stated on a previous occasion, based on his analysis of the number of gardaí needed, we will increase the number. Now that Deputy Rabbitte has changed his long-held view on these issues I would have thought he would be more supportive of our policies. I assure the Deputy these policies work. He used to believe——


——the country was doing well when the debt ratio was 120% and we borrowed heavily. He believed that society was better when we were borrowing billions and raising taxes. I congratulate him for joining us. It took him 20 years but I always knew he was a nice person and that he would come around to my way of thinking some time in my lifetime. I thank him again for his concern for the Minister, Deputy Brennan, who is always very pleased that Deputy Rabbitte takes so much notice of what he does at the weekends and, now, what he says mid-week.

I thank the Taoiseach for his kind compliments. Will he answer the questions for a change? What is the cost of this Niagara of destruction? What is the cost of undermining the social insurance fund? What is the cost of the damage he has done to the confidence of the Minister, Deputy Brennan?

A woman came up to me on the street yesterday and told me that, like myself, she was watching the Taoiseach on Saturday night. She said she thought the Taoiseach's nose would come out through the screen. She said she did not believe a word he said.

Is that the same woman Deputy Rabbitte is always meeting?

The Deputy should stop meeting strange women. They are not good for him.

At the end of all of that, the Taoiseach had time to visit the recycling centre. However, he could not identify the recycling centre to which he went. He certainly goes a long way to recycle when he visits facilities in Drogheda and Wexford. I presume he puts the material to be recycled into the boot of his ministerial Mercedes because he does not have a car of his own and does not drive.

Nobody would believe what the Taoiseach says. He is only short of playing cricket on some spare patch of ground. He jumps on the bandwagon in respect of anything that becomes popular. The only thing he recycles is other people's ideas.

What would be the cost to the social insurance fund? How is it that 2% off the standard rate of tax would cost €1.023 billion and 1% off the marginal rate €211 million? That does not factor in indexation which relates to wages, not the CPI. In addition, it does not take into account the doubling of the carer's tax credit. All of this amounts to €850 million per annum, according to the Taoiseach. During the prudence period the Minister for Finance said everything would be clear and fully costed. I am asking the Taoiseach to indicate the cost of the package he outlined at the weekend. What would be the cost of the income tax changes? By how much would the insurance fund have to be topped up? Is he certain that we would be able to pay social welfare benefits and pensions, particularly in the aftermath of what he has done to the social insurance fund?

What would be the cost of the package outlined by the Taoiseach? Why did he reverse engines mid-week after he had sent out the Ministers for Social and Family Affairs and Finance, Deputies Brennan and Cowen, and informed his backbenchers that it was a matter of steady as she went and that prudence was the way to manage the economy? He threw promises around like confetti. Is it any wonder the woman to whom I referred thinks he is similar to Pinocchio?

The Deputy definitely got out of the wrong side of the bed this morning. He has been narky since he entered the House at2.30 p.m.

I wonder why.

I am sorry if either I or the woman whom he met yesterday upset him. However, I assure him that we will provide full costings in respect of the various matters to which he referred. I give him full marks. He has a hard neck to inform me that I have come onside in respect of tax reform.

Aithníonn ciaróg ciaróg eile.

The Deputy made a career——

I asked the Taoiseach to provide costings.

I am answering the Deputy's question.

The Taoiseach is not doing so.

The Deputy made a career for himself, both in the trade union movement and the various parties of which he was a member before becoming a member of that of which he is currently leader——

At least I was in the trade union movement.

Is the Deputy stating I was never in the trade union movement?

Of course, the Taoiseach was not in it. He used to turn up when everything had been resolved in order to claim the credit. I remember that well.

I was in the trade union movement when those involved were plotting to throw the Deputy out of it. I remember that well. The Deputy was closely involved with subversives. Both he and I remember those days.

There are only sitting three days left until Easter. It will get better.

The Deputy was a member of the infamous group to be found in Gardiner Place.

He jumped over the fence.

We will give item by item costings in respect of everything contained in our tax package which remains well within the parameters of what we announced in each budget in the past six or seven years.

The position is the same with regard to the social welfare package.

That is utterly untrue.

The Deputy talks too much. He is aware of that fact.

The social security fund and the pension fund which contains almost €20 billion are both strong. The social insurance fund is at an all-time high. Difficulties would only arise if the Deputy was to get his hands on either fund. He is of the view that long-term plans are a bad idea. He would like to gain access to the funds in order to introduce some crazy initiatives in respect of them.

The Taoiseach would love me to get my hands on them in conjunction with him. That is the problem.


We ensured, from a legislative point of view, that even if we were in government together, the Deputy would not be able to get his hands on them. That is how it will remain. I apologise for ruining the Deputy's weekend. I assure him that the Minister for Social and Family Affairs, Deputy Brennan, is very well.

Due to gross mismanagement on the part of the HSE and the Pontius Pilate attitude of the Minister for Health and Children, her Department and the Government, the intended opening of the new maternity hospital in Cork did not proceed as planned. What steps is the Taoiseach taking to address the very serious delay in the opening of that new facility? What has he done to advance the objective of ensuring the hospital will be fully operational as soon as possible? Will the matter be resolved this week? What is the Taoiseach's view of the statement by the Minister for Health and Children that the dispute is all about money? Does he agree with the overwhelming majority of Deputies and members of the wider public who are informed on the issue that the concerns of the midwifery and nursing staff who will be taking up positions in this new facility have always revolved around matters of safety and staffing levels? Has he noted the concerns expressed by the Irish Nurses Organisation over a period of six months in respect of the requirement to have a full complement of fully trained midwifery and nursing support staff in situ in advance of the opening of the new facility? Is he aware that it was only in the days immediately prior to the poorly planned opening of the facility on Saturday last that the HSE exposed the fact that it did not have the required number of staff in place?

This is a serious matter which is indicative of the gross neglect displayed by the Department and the failure of the HSE to fully discharge its responsibilities. The Minister for Health and Children, in her disgraceful contribution in respect of this matter, as much as accused the midwifery and nursing staff intending to take up posts in the new facility and the wider nursing community of greed. How does she balance this against the revelation in the past week that three advisers to the HSE chief executive, Brendan Drumm, received up to €1 million — including an overtime rate of €1,500 per day — in the 15 months to January this year? How can the Government have the gall to accuse nurses involved in the front-line delivery of health services of greed while trying to stand over and justify the outrageous abuse and misuse of public moneys I have outlined?

I will outline some of the facts relating to this matter. As consistently stated, I support the Labour Court's recommendations and hope this matter will be resolved during the week. Cork University Maternity Hospital is a new, state-of-the-art €75 million facility which contains 144 beds. It replaces three outdated maternity hospitals.

We want to know why it is not open. We have in our possession the information the Taoiseach is attempting to provide.

Deputy Ó Caoláin had an opportunity to ask his questions and must allow the Taoiseach to reply.

That information is contained in all the press releases.

Is that the Deputy's supplementary question?

It is an annual budget of €60 million. At all stages the HSE advised that the hospital would be opened on a phased basis and would be fully operational by the end of this year.

The Cork University Maternity Hospital was due to open last Saturday. Deputy Ó Caoláin is correct in that regard. Some 128 of the 144 beds were ready and due to open on that day. The HSE, consultant staff and the midwifery management were completely satisfied that 128 beds could have safely opened last Saturday, and they are the people to make that decision. There was a major operation put in place to assist the transfer of all women from the existing three maternity hospitals.

The hospital failed to open following a ballot by the INO members last Friday rejecting the Labour Court recommendations. The Labour Court's recommendation 18661 stated that the facility should open as planned on 24 March. The HSE accepted the Labour Court recommendations and the INO cited insufficient staffing as the reason for refusing to move to the new hospital. The HSE has set a new date of 31 March, and remains in daily communications with the midwives due to transfer to the new service. Some 125 beds will transfer from the three maternity hospitals.

Deputy Ó Caoláin stated there were no posts and a lack of staff, and that is not the case. The HSE has created 264 new additional posts of which 146 are midwifery nursing posts for the new Cork University Maternity Hospital. The staffing rate for the hospital is the best in the country, with a 1:23 birth ratio.

When the facility is fully operational, the midwifery nursing complement will be 375. Currently, there is a short-term issue in filling all the posts, but 32 student midwives are expected to graduate after the summer and all of them will be offered employment. The HSE will make up any short-term staffing with overtime and agency midwives.

Midwives and nurses are rostered to attend induction training and orientation in the maternity hospital this week. Some 75 midwives have already attended orientation training.

Those are the facts. Hopefully, this state-of-the-art €75 million facility with 144 beds replacing outdated services will open this weekend.

On that last point, we certainly agree it is a state-of-the-art facility and one that should be opened immediately. It is all the more incredible, therefore, that the Minister has failed to make the required intervention to ensure the adequate staff are in situ in advance of the opening of the facility, as was clearly a requirement, not only of the INO but, indeed, of the wider populace who would be using it.

The Taoiseach must acknowledge that the integrity of the nurses and midwives in the Cork area who would be employed there is in question by the Minister's charge that this was all to do with greed and money. Does he agree that midwives and nurses are the people at the coalface of the delivery of the care to expectant mothers presenting for birth at this and every other facility, and they know first hand and best the level of cover and the various requirements that are necessary to ensure the safe delivery of a new generation of young children in that city and county?

I ask the Taoiseach to clarify his position. Does he understand the reason the midwives and nurses have rejected the proposition and, indeed, the further points put to them by the INO in an effort to see if there was another way through the difficulty? They have given a clear answer and the INO senior executive must follow through on its membership's decision. The Government also has a responsibility to follow through on that decision, that is, to ensure there is adequate staffing cover immediately. What steps is the Taoiseach taking to ensure this state-of-the-art facility is up and running before the end of this week?

It is the old story, is it not? One day it is that there are not state-of-the-art facilities and the next there are state-of-the-art facilities and people think up some other reason.

It is great that there is one. It makes a change from closing maternity units in Monaghan and elsewhere.

Deputy Ó Caoláin, please allow the Taoiseach.

It is the HSE, consultant staff and the midwifery management, not people out on the streets or any individual member of staff, who are the people who make the call. The HSE, the consultant staff in the hospital and the midwifery management were completely satisfied, and that is the issue. It is not Deputy Ó Caoláin's function or my function. The people with responsibility, the people in management positions who are paid for management positions, which Deputy Ó Caoláin obviously has a difficulty with — I am not getting into that — are the ones who made the call.

The HSE went to the Labour Court. The Labour Court issued its recommendation As always, I am consistent on that and stand over the recommendation. The Minister for Health and Children, Deputy Harney, acted honourably throughout.

The INO cited that there were insufficient staff — I have already given the reason in that regard. The INO also sought relocation payments of €3,000 and €5,000, and additional promotional posts. The relocation payments claim was rejected by the Labour Court, but it did recommend an additional one day's leave be granted on a once-off basis and that was accepted by the HSE.

Deputy Ó Caoláin asked about the additional posts. The HSE has created 146 midwifery nursing posts for the new Cork University Maternity Hospital, which is the best ratio in the country, and when it is fully operational there will be 375. As I stated, the midwives and nurses are rostered on a basis that is well known.

Obviously, it is an industrial relations matter and it is not for me to give my personal view on these issues. It is a matter of fulfilling a Labour Court recommendation. I hope the matter will be resolved so this state-of-the-art facility can be opened as soon as possible.