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Dáil Éireann díospóireacht -
Tuesday, 8 Apr 2008

Vol. 651 No. 2

Leaders’ Questions.

One of the major failures of the Government in the past ten years has been its inability to plan properly and match resources to plans that have been conceived. Nowhere is this more evident than in the workings of the Health Service Executive, HSE, which has become a monstrosity. Every day we see evidence of gross mismanagement and an inability to use facilities for which the taxpayer has paid.

This week I have evidence that a mother of six children was sent notification from the HSE to attend for oncology services on 23 September 2008. However, she has been deceased for 17 years. Last week there was other evidence of this nature.

For years the HSE, supported by the Government, particularly the Minister for Finance and the Minister for Health and Children, has said it is working on plans to provide a new regional hospital in the north east. According to its official website this project will take five to seven years to complete. Unfortunately, in pursuit of this project, the taxpayer has had to fork out hundreds of thousands of euro for consultants to write a report on where it should be located. Last Friday the cat was let out of the bag when the mild-mannered Minister for Foreign Affairs said there is no money to build such a facility. Until now the Minister for Finance, Deputy Cowen, and other Ministers, including the Minister for Health and Children, said this is a major flagship project and that health infrastructure, which was allocated €5.8 billion in the national development plan, would have first call on major projects, even before Exchequer cuts on taxes.

The Government has reneged on its commitment to cut taxes. I ask the Taoiseach to publish a list of the capital projects in the health area, contained in the national development plan, that are to proceed and a list of the projects that are not to proceed? After ten years the Government must provide clarity on this major flagship project, or phantom, as the case may be.

I do not know what error led to the first issue raised by the Deputy but I apologise to the family involved as such things should not happen.

No decision has been made by the Government or the HSE on the location of the new regional hospital in the north east. No proposal has come before the health committee or the Government in this regard. The HSE stated about 18 months ago that it would examine the services and that a hospital in one location would be best for the region covering Monaghan, Cavan, Meath and Louth. It has examined the long-term feasibility of various options and at this stage no proposal has been made. Deputy Kenny should not be surprised that resources have not been set aside in the capital programme for a proposal that has not even been made by the board of the HSE.

The multi-annual programme for health and the annual capital programme are published every year around May or June by the HSE, as the health boards did previously, in conjunction with the Department of Health and Children.

The priority, the immediate task facing the north east, is the organisation of services relating to patient safety. The Government has put significant resources into that area. The HSE advised the Department that it recently received a report from a consultancy firm it commissioned to carry out an independent study on the possible location of a new regional hospital. That study was to take into account the various criteria, including demographics, access, planning, development considerations and inter-dependencies. The HSE has indicated that the report is scheduled to be discussed by the HSE at its board meeting tomorrow. Funding, through the national development plan, for the development of services in the north east will be allocated in the light of specific plans to achieve patient safety and quality care objectives. The big task in the north east for the next few years is to ensure the present hospitals and, particularly, the designated hospitals build up first class patient services and that the other hospitals provide the services allocated to them. That is a task that hopefully can be implemented over the next few years. The optimum and long-term plan is obviously some years away.

This is probably worse than we had thought. I accept the Taoiseach's apology to the family of the deceased person. It should not be necessary for him to have to do this but I am glad he did because of the blatant failure of HSE management to deal with it properly. One can understand the hurt caused.

The HSE website states "welcome to northeast health.ie". It goes on to say that the HSE is working in the north east to develop the most modern, integrated, safe, patient-focused service that has ever been devised in this country and it will be based around one new regional hospital. The Minister for Health and Children, Deputy Harney, said on 14 June 2006 that the Teamwork management services report and the report by Judge Maureen Harding Clark on Our Lady of Lourdes Hospital conclude that the five local hospitals where acute services are provided are not up to standard and that we want to build best international practice supported by a new regional hospital. This apparently has become a phantom entity if we take what the Taoiseach has said here today. He is right to say that designated hospitals within the region should have a service built up that is commensurate with best standards. One can understand the complete frustration of people in that region when the Minister, Deputy Harney, the Government and Professor Drumm have created a pointless crisis where services have been being stripped away from Monaghan and from other hospitals in the locality on the basis that the extra services would be provided in the new regional entity.

Cavan Hospital and Our Lady of Lourdes Hospital in Drogheda are bursting at the seams. The medical personnel at Our Lady of Lourdes Hospital told me that its section dealing with children is on the edge and lives with pressure every day because of the extent of the work taking place there and the lack of facilities. The Taoiseach has not said whether this was in the national development programme. The Tánaiste said in 2006 that we would have a new regional hospital. We are going to provide international best standard in a new regional hospital. What is in store for the existing five hospitals in the north east? What extra services will be built up in Cavan Hospital and in Our Lady of Lourdes Hospital in Drogheda? What services will remain in Dundalk, Monaghan and Navan hospitals? Even if authorisation was given for this to go ahead today, it is a ten or 15 years project and could cost up to €1 billion. What has happened is a pointless crisis. Professor Drumm said this morning that the HSE is entitled to strip out services on the basis that people had an expectation that a regional entity would deal with all of these facilities for the times ahead. Was this new regional hospital ever in the national development programme? Will the Taoiseach publish a list of the capital projects that will go ahead under the national development programme and a list of those that will not go ahead? Can I take it that the commitment of Government and the Ministers for Finance and Health and Children is to ensure that the existing hospitals will have services allocated to them developed to the highest standard? Will he confirm whether the Government intends to go ahead with the regional hospital for the north east which has been the cause of so much angst, frustration and concern for medics, people and patients alike?

Perhaps the Deputy would tell the House whether he is for or against it.

The Deputy is for it. Good.

Unlike the Minister's crowd when——

The Taoiseach without interruption.

Has the Minister changed Departments or is that wishful thinking?

Please allow the Taoiseach to reply.

There are two separate questions here. Deputy Kenny asked the position of the five hospitals in the region, Cavan, Monaghan, Drogheda, Dundalk and Navan. The immediate money in this year's capital programme and the next few years capital programme, as Professor Drumm pledged at recent meetings, is to provide better standards of service in those hospitals and to ensure they have sufficient expert staff at every level to provide a top class service. He has stated publicly on numerous occasions that in some of those hospitals, services would be taken from them and developed in some of the other hospitals. It is his view that mainstream consolidated services would provide the best service from a health and patient safety point of view, build up critical mass and avoid the kind of issues mentioned in some of the recent reports.

That has not happened. It is not a saving.

Obviously, some of the other hospitals in the region, rather than being acute hospitals, will develop services probably more orientated towards day cases and particular services but not sophisticated surgery. He has made that clear. To do that will require significant resources to develop the hospitals that are considered to be the acute hospitals — having coronary care units, intensive care units and the other sophisticated services required. Those services will not be available in all five hospitals. That is the process that is being developed and has been stepped up in recent years. All of the hospitals will be there but will replicate or duplicate the same services or specialties. Clearly that is the position.

The HSE did commission its own independent study. The view of the consultancy firm was for a possible location for one regional hospital in the area. Obviously that would not mean that all the other regional hospitals would close but that would be the centre of excellence that would carry the main specialties. The position is that the HSE has only now advised the Department that it has received a report, prepared by a consultancy firm which it commissioned to carry out an independent study on a possible location for a regional hospital. The study was to take account of the various criteria, looking to the next ten and 20 years of demographics, access, planning, development considerations and other inter-dependencies. I have not seen that report, or a report on that report. I chaired the health committee but I have not seen any outline of the report. I understand it has not been discussed by the board of the HSE. I understand it is on the agenda for tomorrow. The Deputy asked if the Government has signed up to something nobody has seen, that has not been discussed by the HSE and if it has provided resources for that and the answer is we have not made that decision. It would not have been wise if we had made that decision.

We have huge resources in the national development plan for health, some of which are designated and included in the multi-annual report. Every year we issue a detailed report, down to the last few hundred thousand euro of what will be spent by the HSE across the country. It is included in the multi-annual report and block figures are included for future developments which are not specified. If the Deputy asks me if we are going to start this hospital, agree the location and have it built in the space of the next national development plan, by 2012, I do not think it is likely based on the time it takes to undertake major hospital developments. It is not going to happen.

Is it seen as best practice that we agree on one state-of-the-art hospital for the north east? If all the expert opinion is that this should be done, putting main specialties and critical mass of the hospital for that region into one location, the Government will agree. This must come secondary to what the Government is adamant on. We want to see existing services for the present day population — people who need services now — built up and properly maintained and sustained for the future. Longer term plans are for the longer term and we do not want to start closing and displacing services, making life difficult for the present day population, particularly the aged, in advance of having a clearly articulated plan in the long term.

That is what the Government did with cancer services.

That is what the Government has been doing for years.

We are not going to do that, which is why we are putting huge resources into our acute hospital and community services.

The Taoiseach should go to Monaghan.

We will continue with the plan, which is Government policy. That will remain Government policy.

It is not the policy.

If that remains the Government policy, the Government will not remain.

Sinn Féin created a lot of hospitals.

In the month of March, unemployment rose in the State by 12,000, the highest monthly increase ever recorded. It is not entirely due to construction because the numbers are equal for men and women. It is not a blip because in the first quarter of this year, we have seen the highest rise in unemployment in a quarter for over 30 years. The previous high was in 1975, in the middle of the oil crisis.

In the first quarter of this year the Government took in €600 million less in tax than expected. On top of that, a report on the number of new house registrations in the month of March shows the figure has fallen to less than 1,000, down 73%. On top of that the Minister for Foreign Affairs, Deputy Dermot Ahern, told us there is not a red cent to build a new hospital. Is that true? Is it true that there is not a red cent to build a new hospital and is that an accurate summary of the state of the public finances? Is that the bottom line on the stewardship of Minister for Finance, Deputy Cowen, of the public purse that there is not a red cent left to build a public hospital?

Can the Taoiseach tell the House the new initiatives, if any, the Government intends to take to deal with the changed and changing economic circumstances in which we find ourselves? Does the Government have plans to protect employment in businesses? What plans exist to provide for those losing employment? What new initiatives does the Government intend to take to deal with the new economic times?

As it does every year, the Government will spend something in the order of €15 billion to €16 billion in the health services plus an enormous capital programme. I will not go back over the issues in health.

Regarding Deputy Gilmore's economic question, and on unemployment particularly, in responding to issues of an economic and fiscal nature we have been upfront about the risks for the past six months. It is important to remain calm and avoid taking short-term, knee-jerk reactions that could damage our long-term prospects. As I continually said in the House, when the full figures for 2007 were produced, we would see that the economy was strong, if contracting in the last quarter. We know the GDP rate for last year and that the economy grew by 5.4%, far higher than people expected.

The situation in the markets over the past month reflects international issues rather than specific Irish concerns, as we are all aware. From our economic position the fundamentals are very strong, a fact borne out by the national account figures, which are there for everyone to see. Employment continues to grow, there are very low national debt levels and we have a very flexible economy. This is not just my view but the view of most economic commentators. We are addressing the short-term challenges from a position of strength. Our medium-term prospects are favourable. The lowest economic figure for growth for this year from the economic houses is not in the negative — it is 2.2% and rising to 3.5% next year and still growing in a difficult period.

Last week's Exchequer returns indicate a very good performance in income tax, which is up 5% on the same period last year. This shows the real health of the Irish economy and reflects the most important part of economic activity, employment, which remains strong. It is a positive indicator of the resilience of the Irish economy, even at a more difficult time. We are not complacent and fiscal policy is addressing the more pressing economic situation in a number of ways. The Deputy's question is a fair one and in response I will refer to three of those ways. We are giving priority to measures that enhance our productive capacity. The continued roll-out of the national development plan at the highest level this country has ever done and far higher than any other European country at over 6% is giving us an infrastructure and investment programme that is helping the economy through a difficult period. We are slowing the rate of the increase in current spending, which is necessary, and we are removing uncertainty in the housing market through the changes made in stamp duty and increases in the ceiling for mortgage relief and interest rates.

In the past three and a half years, from autumn 2004 to spring 2008, a relatively short period, employment has grown by 243,000 or 13%, with unemployment increasing by only 15,200 in the same period. It is generally accepted that the rate of growth in the economy and in employment over the past few years could not continue at that rate. Still, we are in a very strong position. Looking back over that period, with almost 250,000 jobs created and unemployment increasing by only 15,000, the figures speak for themselves. The live register figures for March, released recently, show the number of people signing on has increased to almost 198,000. That is the highest since August 1999 and the highest at this time of the year since March 1999 and reflects these increases. Looking at what is happening in the economy and quarter on quarter growth, we are still in an extremely healthy position, but we must manage ourselves through this period. With almost 2.25 million people working in the economy, we are in a strong position to get through what is hopefully a short-term difficult position, which is how the Central Bank, the European Central Bank, the OECD and every economic analysis group here and in the European context views this.

That reply is delusory.

The message the Taoiseach is giving the House in response to what we all know are changed and changing economic circumstances — that the Government will continue to do what it has been doing — is depressing. The idea that the situation is due to international circumstances and has nothing to do with us domestically is wrong. To paraphrase our good friend, the former American President, Bill Clinton, "it is not the international economy, stupid". This is about events in the domestic economy to which the decline in revenue, capital gains tax and VAT is directly related.

The unemployment figure is 200,000. When it was 200,000 some 20 years ago, people marched in the streets about it. People are losing their jobs. The problem must be addressed by new initiatives. I will suggest a couple. First, building workers losing their jobs in residential construction could build schools. We have a schools programme that could be accelerated and the skills required in building schools are approximately the same as those required in residential construction.

Second, there could be a training and upskilling programme through FÁS and the educational institutions so that we do not make the mistake made previously, that is, people going onto the dole when they lose their jobs. We should have a system whereby people who lose their jobs can avail of opportunities to retrain and upskill.

Third, it is manifestly clear to all of us that cuts are being effected in essential public services——

——such as home help and other areas that are under the radar and do not get the type of attention they would normally receive. To make a practical suggestion, if the Taoiseach, the Minister for Finance or another Minister is considering cuts in areas of public expenditure, he or she should concentrate on cutting waste rather than essential services.

I do not want to get into a debate on last week's figures, but if the Deputy looks at the figures, which his question was about, concerning the performance of taxes he will see that income tax is up 5% compared to the same period last year and is directly related to employment, showing the real health of the Irish economy and reflecting how the most important part of economic activity, which is employment, is remaining strong in a period where there is a sharp international downturn mainly because of sub-prime lending and the fact that oil is at over $100 per barrel.

I do not want to get into a debate about the figures but, if we are talking about unemployment being at 5%, when we had marches 20 years ago, lest the Deputy forget, it was because we had managed and were lucky to keep unemployment at just under 20%. Our labour market 15 years ago when I was chairperson of the Cabinet committee on employment included 1.25 million people working. Today, we have 2.25 million people working, a substantial part of which has been an increase in recent years.

Overall, if one looks at tax receipts on income, we were €600 million or 5% behind target in the first three months of the year. Over half of the shortfall is due to the poor performance of capital gains tax, which reflects the more adverse conditions in equity and property markets. That is the analysis of those in Revenue and the Department of Finance who have looked at this issue. It is largely driven by the necessary housing market correction, which is well under way. It is a source of satisfaction to me that, for the first time since 1999, the Central Bank is saying that house prices are at sustainable levels. In no way should we feel anything other than satisfaction in that regard. If the Central Bank can say for the first time in nine years that house prices have reached a sustainable level, it supports the recent actions the Government was forced to take.

Yes, it is a fact that taxes are down in the area of development lands and that developers are not developing as much. The only ironic thing about this is that, while I have spent my entire period as Taoiseach defending the fact that it is a good thing for the economy that developers and development land were moving ahead and striving, now that it has come down for the first time, it is seen as a criticism. I am glad to see that the view articulated on this side of the House — that a construction industry, development, capital gains tax and capital-related taxes are good for the economy — is shared for the first time in the period in which I have been Taoiseach by everyone else in the House.

It might make a few schools and social housing possible.

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