Dáil Éireann díospóireacht -
Tuesday, 22 Apr 2008

Vol. 652 No. 2

Leaders’ Questions.

Deputy Enda Kenny

Last week, bearing in mind that Deputy Bertie Ahern will not be Taoiseach for much longer, I raised with the Tánaiste the case of a 76 year old patient with Alzheimer's disease who was on a trolley in the Mater Hospital for four days. The Tánaiste dismissed my point as being facile and simplistic. I find this extraordinary if it is the new philosophy in Fianna Fáil. It is neither facile nor simplistic and the circumstances described are experienced by hundreds of patients in accident and emergency units every day.

I make no apology for bringing to Members' attention a case brought to the attention of Deputy James Reilly. Relevant lines of a letter sent by the mother of a 13 year old read:

Our 13 year old daughter suffers from depression and anxiety and last week took an overdose for the second time. We met with the medical team and they explained to us that she was at high risk of harming herself and needed to be hospitalised. They explained that she needed to be admitted to Warrenstown or St. John of God's. I cried but the worst was yet to come when they told us that we would have to wait four to six weeks for a bed. Today her mood is the lowest I have experienced yet. She needs to be hospitalised but there is still no bed available in Warrenstown or St. John of God's

That is neither facile nor simplistic. The family, one of hundreds, must live with those circumstances every minute of every day. Does the Taoiseach not feel a sense of guilt that, in spite of expenditure of €15 billion on the health system, a depressed 13 year old young girl with the potential to self-harm cannot be given a bed in a hospital for the next four to six weeks? We remember other tragic cases of people who had to wait for treatment and who are unfortunately no longer with us. How can a young girl so desperately in need of attention be left in circumstances on foot of which her distraught parents must refer her case to the Minister for Health and Children and Deputy James Reilly?

Is this not symptomatic of the circumstances in which the HSE is faced with a deficit of €300 million and in which the Minister for Health and Children is clearly and patently unable to deal with the crisis that is now spreading through the veins of the health system like wildfire? Is this not symptomatic of all the cutbacks that leave a 13 year old defenceless in circumstances in which the State is unable to come to her assistance? Can the Taoiseach indicate whether further cutbacks are coming down the line under the watch of the Minister for Health and Children through this monstrosity that has been created in the HSE?

The Taoiseach

A number of questions were raised by Deputy Kenny. On the case of Mrs. Margaret McEntee, which I think is the case to which he referred, I was very concerned by reports regarding the time which this lady spent in the accident and emergency unit of the Mater Hospital. The HSE advised that the patient presented to the hospital on 14 April and was admitted on 17 April. As I have said previously here that is outside of its own figures — even the figures it presents to us. Clearly it is an unacceptable situation. The hospital's patient liaison officer was in contact with the lady's family during the time and the hospital has conveyed its regret for the time she spent awaiting admission. That has not been the norm these past few years in the hospitals. They report through the health committee monthly on the totality of the position and that was way outside of its own guidelines and benchmarks on which it is improving all the time. The hospital is working closely with the HSE in seeking to manage and improve the flow of patients through the hospital and the accident and emergency department. The focus is on improving the internal processes where possible and on the provision of appropriate community support services. From the Minister's and the Government's perspective, improving the delivery of accident and emergency services will continue to be our top priority.

The daily average number of patients awaiting admissions in the month just gone was 107, compared with 105 a year a go, which is practically the same. The average daily figure for April to date is higher than the reported average for the same period of last year. There are many reasons for that. The colder weather has continued. Deputies will recall that April last year was a far warmer period and this affects the figures. If one looks at the figures, there is a huge difference between what they were in the first half of April last year and the first half this year. However, the HSE has put in place a framework to collect and deal with these issues and try to improve them. It has also taken on additional beds to try to improve the delayed discharges. I think it has 200 more beds than it had. It states in the figures it presented to us that there are far more delayed discharges than there were last year.

I should also mention the phased opening of St. Mary's. There are 100 beds which are opening at a rate of ten per week. That was scheduled to commence at the end of March. This timeline has been adjusted to take account of staff recruitment. It will start next week on 1 May. Some 70 beds in Cherry Orchard have also opened and 24 beds will open when the staff have been recruited, which is ongoing. These beds will be used mainly for older people who have completed the acute phase of their treatment and are at present in the hospitals. Some months ago I said I would keep the House updated on those figures. Those beds are now in the process of opening. Between the three of them there will be 170 beds in addition to the 200 that have been provided.

Obviously I do not have details on each individual case. However, I can tell Deputy Kenny that regarding the consultants' contract that has just been completed, 15 of those consultants' contracts are for those consultants who are involved in child adolescent services. This is a substantial number of consultants. There are also extra beds in St. Vincent's in Fairview, in St. Stephen's in Cork and in Galway. Obviously those consultant posts are now in the process of being advertised as part of the agreement with the consultants. Those posts will bring with them the additional beds in St. Anne's in Galway, St. Vincent's in Fairview and in St. Stephen's in Cork.

Deputy Enda Kenny

I give the Taoiseach credit for his more caring response than that of the Tánaiste who said that to raise an individual case here was facile and simplistic. The case of the 13 year old I have raised with the Taoiseach is in the possession of the Minister for Health and Children and nothing has happened. This is the case of a 13 year old depressed and anxious girl, who has been medically assessed as potentially committing self-harm. She has now been told she will need to wait for four to six weeks for a bed in Warrenstown House or St. John of Gods. The Minister for Health and Children should not hide behind the Health Service Executive and attempt to get away with this. Health is not just about economics and statistics. Politics is always about people. I will make no apology for continuing to raise individual serious cases in this House, the forum of the people.

Deputies

Hear, hear.

Deputy Enda Kenny

The Minister for Health and Children should not continually attempt, as do her colleagues, to hide behind the Health Service Executive and claim it is its responsibility.

Deputy Mary Harney

It is marked against proper standards since last October.

Deputy Enda Kenny

The Minister is continually hiding behind the Health Service Executive and has failed to do her duty.

The Taoiseach mentioned extra beds. Perhaps he could take this matter to the Minister for Health and Children. We are now faced with the closure of a medical ward in James Connolly Memorial Hospital for a full month in the summer; the closure of a surgical ward in the same hospital for a full month in the summer; the cancellation of all outpatient clinics for two full weeks in summer and December in James Connolly Memorial Hospital; the halving of beds in two wards in Tallaght from 60 to 30 from next week; the cancellation from June of "hospital in the home" which allows patients to be discharged home early; reduced services in Monaghan and Dundalk without any extra resources being put into Cavan or Drogheda; respite services being cut; and cancer services being cut in Sligo and in Mayo without being replaced. There is a consistent pattern here with hundreds of patients from all over the country now streaming into Deputies' clinics because they cannot get medicines from 1 May. Fianna Fáil Deputies are saying this is a matter for the HSE. As outlined by Deputies Jan O'Sullivan and James Reilly at the Joint Committee on Health and Children, the Minister for Health and Children instructed the HSE to get on with it.

All of these cuts indicate either that the Taoiseach does not know or that the Tánaiste and incoming Taoiseach does not care. In the final hours left to him in the powerful position as Taoiseach, will he take aside the Minister for Health and Children, who has been a loyal servant to him over the years, and ask her to direct the Health Service Executive, as is within her authority, to produce a plan to reject front-line cuts in services for thousands of patients across the country? If he does that before he leaves office he will at least have done some good given that we have a health crisis being presided over by the Minister for Health and Children who will not accept any responsibility for it but passes the buck continually to the Health Service Executive.

Deputies

Hear, hear.

The Taoiseach

A Cheann Comhairle——

Deputy Mary Harney

Deputy Kenny marched against——

(Interruptions).

An Ceann Comhairle

Allow the Taoiseach to speak without interruption.

Deputy Mary Harney

What about Deputy Kenny only five months ago?

A Deputy

You should hear what they say behind your back.

An Ceann Comhairle

Allow the Taoiseach to answer.

Deputy Olivia Mitchell

They are still marching.

The Taoiseach

I state again what I have said many times. In the 53 public and acute hospitals we have provided and continue to provide additional resources.

A Deputy

It is not working.

The Taoiseach

It has not been a question of cutbacks in the service.

Deputy Bernard J. Durkan

It has made reductions.

The Taoiseach

We have continued to employ more people.

Deputy James Bannon

More bureaucratic information.

The Taoiseach

We have continued working with the trade unions to deal with the issue of last September's embargo and we have delivered increased capital expenditure into several developments in those hospitals and will continue to do that. Like every organisation the HSE has to live within the budget agreed in its own plan. It has to manage that throughout the year. Last year there was criticism in the House when it only started doing that in the last quarter. If it is doing it over a longer period of a year, that is the correct thing to do.

There are 130,000 people working full-time or part-time in our public health service. The Government's ongoing investment in the health service has increased every year that I have been here. We have increased the numbers of doctors, nurses and other health-care professionals employed in the public health service. We have invested heavily in the education of front-line staff in personnel to ensure a sufficient supply graduates.

Deputy Seymour Crawford

And getting nowhere.

The Taoiseach

We are continuing to do that. They are in several locations around the country. There is €200 million on the capital programme for this year which has been allocated. We have increased the number of beds. I was answering about the difficulties in the delayed discharges. The reality is we have recently provided 200 contracted beds in private nursing homes, 180 of which were in Dublin. They have now been filled. We are far from cutting back on this issue. We have seen the phased opening of facilities at St. Mary's and Cherry Orchard Hospital and, between them, they will provide 170 beds. These facilities require staff and additional resources. Given the significant number of beds planned for this year and the associated recruitment involved, every unit will require additional staff. While the HSE must manage its budget, this will not stop the extension and development of services in new locations. The House should take account of this aspect.

Deputy Seymour Crawford

There are cutbacks in other areas and there is no home help available.

Deputy Joan Burton

Is the Taoiseach shocked that, as he leaves office, consumer inflation is at 5%, bearing in mind that when he came into office in 1997 he inherited an inflation rate from the outgoing Government of 1.5%? Does the Taoiseach agree that this rate of inflation is dangerous, damaging and disappointing for our economy and country, particularly as economic growth is now faltering in a range of areas? The Government made a fuss in recent years about the abolition of the groceries order but only the price of drink seems to have fallen in the meantime, with negative consequences for society.

In his time the Taoiseach has visited many supermarkets, if not to shop then to canvass, and I am sure he is aware that the vast majority of people who shop for families and push the supermarket trolley are women. They are angry at the exploitation of consumers and the fact that the Government is doing nothing to protect ordinary families from the price increases that are currently being experienced.

Is the Taoiseach aware of the rip-off, profiteering and exploitation being experienced by Irish consumers, particularly at the hands of British-based multiples converting sterling prices to euros? The mark up when prices are converted from sterling to euros can frequently be as high as 50% or 60%. Many surveys have been done in this regard recently and one in the Irish Daily Mail found that Gillette Mach Turbo razor blades, which the Taoiseach may use, sold for £11.99, which should be €15.17, but sold in Boots for €19.49. The price difference in this case is almost 30% greater than the exchange rate difference between sterling and euro. Furniture is more expensive and a wardrobe that might cost £1,500 will cost up to €2,500.

Deputy Noel Dempsey

Unless one buys Irish.

Deputy Joan Burton

Only 90 miles down the road from Belfast, the mark ups can be astonishing. The Government has established a series of quangos, including the Competition Authority.

Deputy Noel Dempsey

That is a serious wardrobe.

Deputy Ciarán Lynch

Perhaps it is where the Minister is keeping the electronic voting machines.

Deputy Joan Burton

The Minister ought to visit stores to see what furniture now costs in Ireland.

Deputy Noel Dempsey

Navan is the home of furniture.

Deputy Joan Burton

Does the Taoiseach have any proposals to ensure the Competition Authority or the National Consumer Agency do anything about this blatant exploitation of Irish shoppers and consumers? We should bear in mind that this is occurring at a time when some people in the Irish Business and Employers Confederation, IBEC, and the Construction Industry Federation are suggesting that workers, particularly those in the construction industry, should take pay cuts. Does the Government propose to do anything about this scandal?

The Taoiseach

On the Deputy's first point, I do remember what the rate of inflation was when I took office. I also remember that unemployment was at 11%, single people paid tax on €72 per week, there was no minimum wage, old people received very low rates of welfare and the preceding Government gave them an increase of £1.50, one of the most miserable increases ever. I remember all of these things.

The annual rate of inflation, as measured by the consumer price index, was 5% in March and I know this represented an increase on February. The increase was higher than expected, as the Tánaiste said, and was well above the forecasts of other analysts. Inflation in the goods sector was 4.2% in the 12 months to March and this is largely being driven by global markets for raw materials, as has been stated by everyone in every sector of the industry. It is essential that these externally driven price increases are not pressed more by internal factors that could adversely impact Irish competitiveness. We must be careful of this. Some commentators have attributed the higher than expected inflation rate to fuel purchases under hedging arrangements, which reduced the positive effects of the strong euro exchange rate. There are many reasons for the increase in inflation; some are accurate and others may be somewhat stretched.

The annual EU measure of inflation, the harmonised index of consumer prices, HICP, gave a rate of 3.7% in March, up from 3.5%. This figure was above the EU average and the gap remained unchanged in March so I do not think we should talk it up more than is necessary. We must work across Departments and agencies to bring inflation into line as quickly as possible and this has already started with the inflation group. We have already been successful twice in this regard during this decade.

The increase in inflation in the past two years was mainly due to external developments, such as increases in interest rates and European prices. We must do everything we can in all sectors to bring it under control and this process has been under way since the autumn through the social partnership process involving employers, trade unions and State agencies. It does not take away from the projections for the Irish economy. Despite the sub-prime difficulties, difficulties in borrowing and those relating to the inter-bank rate for borrowing, the economy is still in a strong position. We must get through this period as the forecasts for next year and the second half of this year are still positive. We must deal with the difficulties that are, mainly, in two or three areas and have been well identified. I assure the Deputy that they will be carefully watched every month.

In the short term, the budget day forecast was for growth this year of 2.8% in gross national product, GNP, and 3% in gross domestic product, GDP. The forecast has not changed in the analysis of the first three months of the year. We are in a more difficult economic environment, something I have made clear since the autumn, and there is no arguing against the fact that a lower level of the building of new houses has changed some of the forecasts made in the budget. To hold revenues as projected in the budget will be more demanding and challenging and there is a more challenging external environment. Practically every country in the OECD, never mind the 27 countries in the European Union, faces these difficulties. The key is to manage our position as best we can and I assure the Deputy and the House that this is what we are doing not only in the Department of Finance, but in all Departments and State agencies.

Deputy Joan Burton

When the Taoiseach entered Government in 1997 the inflation rate bequeathed to him was 1.5% and it is now 5%. Irish exporters and manufacturers who sell goods to the UK face ferocious competition because of the value of sterling versus the euro. British multiples and companies that sell on the Irish high street blatantly rip-off and exploit Irish consumers with astonishing price mark-ups.

When the Taoiseach has spare time in the next several weeks, I invite him to take a stroll through Dunnes Stores, Marks and Spencer and other shops operating on both sides of the Border. He will see items marked at STG£3.50 which are then translated into €6.

Many public resources go into the Competition Authority. What kind of competition allows shops to rip-off people? There are many fine people on the National Consumer Agency. What are they doing to ensure the translation of prices from sterling is reasonable? It is a blatant rip-off.

For some time interest rates have not been increased by the European Central Bank which means it is not driving our inflation rate. We have a falling construction market and an easing of house prices. The Taoiseach's analysis is wrong. We are importing a significant amount of inflation through UK multiples and Irish multiples which buy from the UK, making massive profits through the mark-up from sterling to euro.

Is that fair on the ordinary consumer? What can €50 buy someone in a supermarket? How far does €250 go for a family shopping? It is leaving shopping trolleys half-empty. What does the Government propose to do about this?

The Taoiseach

As I said, the Competition Authority, the National Consumer Agency, Departments and the social partners, as they have done three times this decade, have been examining individual sectors of the economy where there are pressures. Every month those figures are analysed in great detail. They have used their efforts wherever they believe we need more competition. The Competition Authority has produced several reports whose recommendations have been implemented to drive competition in certain areas.

If Deputy Burton's argument were true, the only way of beating this inflation would be through more competition. More aggressive competition is the only way to change that. It is necessary to move away from cartels.

While services inflation is higher, it does not cover the areas raised by Deputy Burton. Taking the figures for the past few months, the consumer price index, CPI, average has been at 3%. The comparable harmonised consumer price index, HCPI, forecast is 2.4%. CPI figures for the year to date imply that forecast may come under pressure if the trend does not moderate in the year. That is the information we have got from the analysis.

The pick-up in inflation is from the knock-on effect of last year's rise in interest rates, as well as price rises in oil and food. There is no doubt that the demand and price increases for food have exacerbated it. There has also been services inflation.

The efforts of the agencies collectively have been to drive competition or watch price-fixing or price-taking by organisations. All State agencies have been actively involved in that for the past seven months.