Dáil Éireann díospóireacht -
Wednesday, 12 Nov 2008

Vol. 667 No. 1

Leaders’ Questions.

Deputy Enda Kenny

As the funeral of Shane Geoghegan takes place this morning, I will not raise the matter of crime as a mark of respect for this much respected young man.

However, I wish to mention a matter I raised last week with the Taoiseach and which is on today's Order Paper. I refer to the HPV cervical cancer vaccination programme for young girls. This programme was announced by the Minister for Health and Children last August. It involves a vaccination which has clearly been shown to prevent cervical cancer and, as a consequence, saves lives. The cost is €10 million. Members on the Taoiseach's side, notably Deputy McDaid, the Minister of State, Deputy McGuinness and, at certain times, the Minister for Health and Children herself have called for cross-party agreement on the issue of health. I do not really want to divide the House this evening on a matter in which there is incontrovertible evidence that the vaccination programme announced by the Government in August and now being withdrawn actually saves lives. Among the cohort of young girls across the country who were to be vaccinated under this programme, a number will inevitably die of cervical cancer.

The Minister for Health and Children says it is either the vaccination programme or the cervical screening programme. It is not; it is both. In this case, €10 million is required. I note the drug companies have said they would defer acceptance of payment until next year, if appropriate. The cost, therefore, would be an administrative charge of €30 per pupil. The Government is to spend more than €10 million — the cost of the entire programme — on advisers, press sections and so on this year. Does the Taoiseach accept that this vaccination programme actually works and that it has the capacity to save lives in years to come? I ask him to review this matter during the course of the day, taking into consideration the very small amount of money involved and the potential to save lives in the future, so that the House does not have to divide on an issue——

Deputies

Hear, hear.

Deputy Enda Kenny

——on which the Taoiseach's own Deputies have called for cross-party agreement from this side of the House. We can have cross-party agreement on this and we can show the Taoiseach how to find that money if he wants.

Deputies

Hear, hear.

The Taoiseach

This matter is being dealt with during Private Members' business tonight so there will be an opportunity for all Members to put their views on the record. Those who get the vaccine must also undergo screening. The vaccine is not 100% effective in preventing cervical cancer. It is important that we do not use emotional language but that we be specific. All people who receive the vaccination must be screened. Screening provides 95% protection against cancer development, but the vaccine does not provide that level of surety. Thus, it is important not to suggest, as some Members seem to be, that non-provision of the vaccine puts people at risk. The screening programme provides 95% cover, which is a far greater level of effectiveness than the vaccination itself. It is important that those facts are stated. The screening programme is the best option. Other countries do not have the vaccination. Finland and Sweden do not use it, for example, yet these countries have strong health care systems.

Deputy Emmet Stagg

We do not have it either.

Deputy Enda Kenny

I repeat that this is an opportunity for the Taoiseach to achieve cross-party agreement on this issue. There is a vaccine that actually prevents cervical cancer. The Taoiseach's response has thrown aside the evidence in the HIQA report that at least 51 lives can be saved over the years ahead by use of this vaccination programme. It is not a question of one or the other. It is both — the vaccination programme and the screening programme. The Government seems to have cast aside the fact that this programme will save lives. It is being withdrawn by the Government on the basis of economics rather than on the basis of saving lives because it costs €10 million to administer the programme.

Deputies

Hear, hear.

Deputy Enda Kenny

Deputy Ring received a response to a parliamentary question in July to the effect that €10 million will be spent this year on special advisers, press officers and support for Ministers. We have evidence of the €8 million spent on consultancy reports. We know that when the Taoiseach was Minister for Finance he sanctioned payment after payment on the famous computer programme, PPARS, for the health system. He also paid out money for the upkeep of voting machines, on which the Government of which he was a member spent €60 million. This amount would have allowed completion of the vaccination programme for six years. This Government has reduced people's lives to economic statistics. The Minister for Health and Children, who is sitting beside the Taoiseach, announced the vaccination programme with great fanfare in August and included conditions which she has now withdrawn. Some parents will now be forced, because of their concerns, to have their children vaccinated at a cost of €500 or €600, while others will not be able to do that. Even if it is only a matter of 5%, the Government has withdrawn a programme that we know can save lives — that HIQA states can save lives — because of its cost.

This party put forward a number of propositions. The pay freeze would bring in €400 million across the public pay sector. Dropping another Minister of State would save €5 million or €6 million. There are so many areas where the Government could save €10 million in the knowledge that it is not just bolstering up bloated administration or facilities for Ministers but putting in place a vaccination programme that will save lives. That is the point. The Taoiseach has an opportunity today to review this programme and not have every one of those Deputies on the Government side, many of whom have genuine concerns about this, forced up the steps to vote against the establishment of a vaccination programme we know can save lives. A 12 year old in school today who would be the recipient of the vaccination programme, which we would support, will have a life to live. Others will not. I do not want it said that the vaccination programme that could have saved the lives of 5% of girls in this cohort, if that is what it is to be, was withdrawn by the Government. The Government has an opportunity to admit this programme works, review this situation and Fine Gael will support the Government in what its members have been calling for — cross-party support on a health issue where we can prove, beyond voting "yay" or "nay", that lives will be saved.

The Taoiseach

The Government motion states that we will keep this matter under review and that motion will be supported by the Government side.

Deputy Paul Kehoe

Like everything else it is under review.

The Taoiseach

Deputy Kenny is making untrue assertions using populist arguments in an effort to——

(Interruptions).

Deputy Enda Kenny

Is the Taoiseach calling me a liar?

The Taoiseach

Deputy Kenny is using emotional blackmail in an effort to make a political argument. He is wrong. No health care system has brought in a vaccination programme before the full national screening programme was in place.

Deputy James Reilly

That is not the argument, and the Taoiseach knows it. He is being disingenuous.

The Taoiseach

We are putting the national screening programme in place, which will save lives in the age cohort that is relevant in this regard by 300,000 people being screened next year.

Deputy Enda Kenny

The Taoiseach pays the advisers and consultants.

The Taoiseach

The Deputy should listen to the facts because I am fed up listening to that sort of argument from him playing emotional blackmail and mock concern by putting out false assertions and trying to create fear amongst the people. He is wrong.

(Interruptions).

Deputy Enda Kenny

The Taoiseach can lecture away.

The Taoiseach

The screening programme——

Deputy James Reilly

Is the Taoiseach telling this House that the HIQA report is untrue? Is he telling this country that HIQA is wrong in its assertion that 52 lives can be saved by the use of this vaccine?

Deputy Dermot Ahern

Will Deputy Reilly give up his €400,000?

Deputy Paul Kehoe

He is not on €100,000 like the rest of them.

Deputy Dermot Ahern

He is on €400,000.

An Ceann Comhairle

I remind Deputy Reilly that we are engaged in Leaders' Questions and he is not yet leader of his party. The Taoiseach is replying to Deputy Kenny. Please allow him to do so.

The Taoiseach

No vaccination programme has been rolled out until the full screening programme is rolled out.

Deputy Emmet Stagg

Did the Government not know that in August?

Deputy Enda Kenny

Why did the Minister announce it in August with a bottle of champagne?

The Taoiseach

That is 300,000 people next year. We will keep this matter under review. It is the screening programme that identifies the pre-cancerous cells and ensures cervical cancer does not take hold. That is the issue. I have listened to what Deputy Kenny said and it is false. The screening programme provides the greater certainty where 95% of all cancers can be identified. The vaccination programme will not go ahead in 2009 but is being kept under review.

Deputy Enda Kenny

It is economics versus lives.

The Taoiseach

That is a wrong statement. It is a nice populist statement and he will get plenty of headlines for it, but it is wrong.

Deputy Paul Kehoe

It is a fact.

Deputy Enda Kenny

The Taoiseach should ask his Deputies McDaid and McGuinness.

Deputy Eamon Gilmore

The Taoiseach says he will keep this under review. It is very simple. Girls aged 12 will either get this vaccination this year or not. Those with the means to get it can do so privately and those who do not will be put at risk. The announcement of this vaccination programme did not come out of thin air. It was announced by the Minister for Health and Children and has been withdrawn by her. There is a very simple solution — the Government can go ahead with this. It is not impossible to find the €10 million to allow this vaccination programme to go ahead. Finding the €10 million will not put the public finances into disarray. It amounts to approximately €500,000 across all Departments and everybody in this House knows those kind of savings and adjustments can and are found month in, month out by Departments in respect of a range of projects.

This is a political question. This is about the Taoiseach making a political decision to allow the vaccination programme to proceed and finding the means by which to do it. The Minister for Health and Children made the decision to announce this vaccination programme in the first place, and the decision to withdraw it. I want to ask about the Minister. At the weekend her party dissolved itself and she said her continuation as Minister for Health and Children is at the Taoiseach's discretion. I respect the Minister, Deputy Harney's integrity and ability, but as Minister for Health and Children she has not been a success. She was responsible for the establishment of the HSE to reform the health service. That has not worked.

Deputy Liz McManus

Hear, hear.

Deputy Eamon Gilmore

She presided over the PPARS fiasco. She was supposed to produce 200,000 additional medical cards and instead she has removed automatic entitlement to the medical card from pensioners. She decided to withdraw this vaccination. The Minister's big idea for providing hospital beds was to turn hospitals into businesses and have them provided by the private sector through co-location. In 2005 she said co-location would fast-track the provision of hospital beds. Three years later we have none of the co-located hospitals, no additional bed, not a single brick laid on brick. On Sunday night the Minister of State at the Department of Enterprise, Trade and Employment, Deputy McGuinness let the cat out of the bag when he said there are some issues regarding funding from the banks and the provision of the co-located hospitals is in doubt.

The Taoiseach can solve the immunisation issue by making a political decision that would have agreement across the House, as Deputy Kenny has pointed out, and would relieve his backbenchers of the embarrassment and considerable personal difficulty of having to go up those steps and vote against it this evening.

Deputy Máire Hoctor

The Deputy need not worry about that.

Deputy Eamon Gilmore

For how long will the Minister for Health and Children remain in her position? What are the funding difficulties regarding co-located hospitals to which Deputy McGuinness referred on Sunday night?

An Ceann Comhairle

The Taoiseach has listened to Deputy Gilmore with respectful silence so I ask Members to respect the Taoiseach and allow him to reply without interruption.

Deputy Pádraic McCormack

If he does not shout.

The Taoiseach

The issue is how we ensure people are protected from getting cervical cancer. Providing a national screening programme is the first step in that effort. We are providing an extra €25 million next year to ensure that happens. We are providing another €15 million to ensure Professor Tom Keane has the proper treatment regimes in place in the centres of excellence he has been establishing. This is an effort to ensure many of the problems that have been highlighted in debates in the House as a result of the old system, which the Opposition seems to defend all the time, do not recur. Deputy Harney has an excellent record as Minister for Health and Children and has been opposed every step of the way by the Opposition in respect of any reform she has brought to the health service.

Deputy Noel Dempsey

Hear, hear.

The Taoiseach

She has been opposed day in, day out by those who want to protect the status quo, the Opposition.

Deputy Liz McManus

That is not true.

The Taoiseach

That is a fact.

Deputy Liz McManus

If she had listened to the Opposition we would not be in this mess.

The Taoiseach

A new, radically improved consultants' contract has been brought forward. A new cancer control programme, which requires people to agree to go to adequate centres of excellence instead of having various cancer control programmes throughout the country, is working. Six months ago, it was vociferously opposed during a debate in this House——

Deputy Emmet Stagg

It was opposed by Fianna Fáil backbenchers and Ministers as well.

The Taoiseach

——by every backbencher in both of the main parties on the other side of the House.

Deputy Liz McManus

The facts cannot be dealt with by a hatchet.

Deputy Emmet Stagg

Is the Taoiseach talking about the Minister of State, Deputy Devins?

The Taoiseach

The largest ever expansion of services for elderly people has taken place under this Minister for Health and Children.

Deputy Pádraic McCormack

What about the people who were sitting outside the gates of the Dáil?

Deputy Brendan Howlin

Thousands of elderly people protested outside Leinster House.

The Taoiseach

New standards for nursing home care are being implemented. The Health Information and Quality Authority has been established. A fundamental change has been made to ensure that standards are set and enforced.

Deputy Paul Kehoe

The Taoiseach should deal with the issue.

The Taoiseach

Means tests for medical cards have been made much easier.

Deputy Emmet Stagg

How many new forms have been introduced by the Minister for Health and Children?

The Taoiseach

The number of medical cards in use has increased by hundreds of thousands since the Opposition parties were in office.

Deputy Paul Kehoe

The Taoiseach should deal with the issue.

Deputy Dermot Ahern

The Deputy should let him deal with the issues.

The Taoiseach

GP out-of-hours services have been opened in north Dublin. Accident and emergency services have been improved.

Deputy Enda Kenny

The Taoiseach is talking about the last century.

The Taoiseach

Waiting times have been lowered. When I was in the Department of Health and Children——

Deputy Ruairí Quinn

The Taoiseach is the man from Angola.

The Taoiseach

People had to wait for years, rather than months, under the stewardship of the Government formed by those opposite. The first ever programme of national hygiene audits has been implemented.

Deputy Caoimhghín Ó Caoláin

The Taoiseach should remove the Minister, Deputy Harney.

The Taoiseach

We have provided for the introduction of nurse prescribing. We have expanded the role of nurses to provide better patient services. We have modernised the regulation of the medical profession. The Minister and the Government as a whole can be proud of the many reforms which have been implemented in the face of opposition from the other side of the House, every step of the way.

Deputy Frank Feighan

Much of that opposition came from members of the Taoiseach's party.

The Taoiseach

The Opposition has no policy on health other than to maintain the status quo.

Deputy Pádraic McCormack

The Government does not have any policies.

The Taoiseach

That is its policy.

Deputy Paul Kehoe

What about the medical cards?

The Taoiseach

As regards the question of budgetary discipline and the need for better policies and proper budgets——

Deputy Paul Kehoe

What about the medical cards?

The Taoiseach

The Deputies on the other side of the House opposed every single——

Deputy Paul Kehoe

What about the over 70s?

The Taoiseach

The Leader of the Opposition wants a stricter budget from his finance spokesman.

Deputy Paul Kehoe

What about the over 70s?

The Taoiseach

I note that Deputy Bruton has not opened his mouth——

Deputy Enda Kenny

The Taoiseach should answer the question.

The Taoiseach

——since he said he wanted a 5.5% deficit, which would involve a further €2 billion of cuts.

Deputy Dermot Ahern

Speak up, Richard.

Deputy Enda Kenny

Who is the fellow who——

Deputy Jim O’Keeffe

We have to pay for the Government's incompetence.

The Taoiseach

They come in here every morning to oppose every economy we make.

Deputy Enda Kenny

Mouth away if you want.

The Taoiseach

They are talking out of both sides of their mouths incessantly.

Deputy Dermot Ahern

You are a brave man, Richard.

Deputy Richard Bruton

I can sense the Government's desperation and panic.

Deputy Dermot Ahern

You are a brave man.

Deputy Liz McManus

What about a direct answer from the Taoiseach?

Deputy Enda Kenny

He should do the statistics justice.

Deputy Pádraic McCormack

What about the Minister who is blaming the Progressive Democrats?

Deputy Eamon Gilmore

I take it from the Taoiseach's forceful reply that the Minister for Health and Children is staying in office.

Deputy Michael D. Higgins

I would say so.

Deputy Emmet Stagg

She looks relieved.

Deputy Michael D. Higgins

It looks like that.

Deputy Michael P. Kitt

Deputy Higgins is offering to take up the job.

Deputy Eamon Gilmore

That answers one of my three questions.

Deputy Mary Harney

The last Labour Party Minister for Health ran out of the Department.

Deputy Brendan Howlin

That is absolutely untrue, Mary, and you know it.

Deputy Mary Harney

If one reads Fergus Finlay's book, one will know that is what happened.

Deputy Brendan Howlin

It is absolutely untrue.

Deputy Ruairí Quinn

That is simply not true.

Deputy Mary Harney

He could not wait to get out.

Deputy Brendan Howlin

I will take the Minister's job tomorrow if she wants to leave.

An Ceann Comhairle

The Minister and Deputy Howlin can resume this discussion somewhere else.

Deputy Eamon Gilmore

The Taoiseach is very exercised about the Opposition opposing the Government, particularly its health measures. We can agree that the measure that was announced by the Minister for Health and Children in August — the immunisation of 12 year old girls against cervical cancer — should proceed. We can agree, across the floor of the House, where the €10 million that is needed to proceed with the immunisation programme should come from. I suggest that rather than coming in here tonight and pursuing its amendment and its opposition to the motion before the House, the Government should propose how the programme can proceed. I invite the Minister for Health and Children to put such a proposal to the Fine Gael and Labour Party spokespersons on health during the course of the day.

Deputies

Hear, hear.

Deputy John Cregan

Deputy Gilmore is playing politics with this issue.

Deputy Eamon Gilmore

If that happens, we will be able to find agreement, across the floor of the House, on at least one measure that will help to protect the health of 12 year old girls. While the Minister is conducting her review, those girls will be getting older and it will be too late to immunise them effectively.

The Taoiseach

That is not true.

Deputy Eamon Gilmore

I asked the Taoiseach about the funding difficulties of co-located hospitals because the problems associated with the shortage of beds in our hospitals are increasing once more. The Taoiseach may not be aware of it, but the trolleys and the corridors are full of people who cannot get hospital beds.

Deputy Ruairí Quinn

Yes.

Deputy Eamon Gilmore

The Government has proposed to provide additional beds in our hospitals. Everybody acknowledges that they are required. I admit there is some difference of opinion on the number of beds. Everybody knows that additional beds are required in our hospitals. The Government proposed to get private companies to develop private hospitals on the grounds of public hospitals. It believed that such a scheme would provide the additional beds which are needed. The Minister of State, Deputy McGuinness, said on Sunday night that the scheme has run into a funding problem — that it is blocked, in effect. We know it has not gone ahead for the last three years. Can the Taoiseach tell us whether it is going ahead? How many hospitals are to be built? Have agreements been signed in respect of many of them? What is the funding difficulty? If the scheme is not going ahead, by what alternative means does the Government intend to provide the beds that are required in our hospitals? How does it intend to ensure that unfortunate patients can get hospital beds rather than being stuck on a trolley in a corridor, with all the indignity that involves?

Deputies

Hear, hear.

The Taoiseach

Significant progress has been made with this initiative. The board of the HSE has approved preferred bidder status for the development of co-located hospitals at Beaumont Hospital, Cork University Hospital, Limerick Regional Hospital, St. James's Hospital, Waterford Regional Hospital and Sligo General Hospital. Project agreements in respect of the developments at Beaumont Hospital, Cork University Hospital and Limerick Regional Hospital were signed in March of this year.

Deputy Eamon Gilmore

That is three projects.

The Taoiseach

The necessary preparatory work for project agreements in respect of the developments at St. James's Hospital, Waterford Regional Hospital and Sligo General Hospital is proceeding. Planning permission has been sought for the Beaumont Hospital project. I understand that it was granted this morning.

Deputy Pádraic McCormack

The Taoiseach had better tell the Minister of State, Deputy McGuinness.

The Taoiseach

Planning permission has also been granted by the relevant local authorities in respect of the projects at Cork University Hospital and Limerick Regional Hospital. However, appeals have been submitted to An Bord Pleanála in each case.

Deputy Jim O’Keeffe

Were they submitted by the Minister, Deputy Martin?

The Taoiseach

The HSE has indicated that it anticipates that the overall construction and commissioning period will be between 26 and 30 months in each case. The procurement process is at an earlier stage in the cases of Connolly Hospital and Tallaght Hospital, which are also participating in the co-location initiative. A tender has been received in respect of Connolly Hospital and is under consideration. Work is being undertaken to finalise the invitation to tender for Tallaght Hospital. The provisions of the project agreements under which bidders entered bids are based on the principle that the State and the HSE should work together to ensure that these projects get up and running. The HSE is involved in ongoing discussions on implementation matters. It is supported by a steering group that comprises legal and financial experts and representatives of the Department of Health and Children. The HSE is working with the developers at each site to facilitate the advancing of the financing of the projects in the context of Government policy on co-location and the provisions of the project agreements between the parties. In all projects of this scale, discussions take place in line with the normal analysis banks make of all risks before they finalise loan conditions. As the Deputy indicated, co-location is consistent with the 2001 health strategy, which stated that the "Government is committed to exploring fully the scope for the private sector to provide additional capacity".

Deputy Pádraic McCormack

This is a filibuster.

The Taoiseach

In the period to 2011, extra beds will be provided by a combination of public and private providers. A strategic partnership will be developed with the private hospital sector to provide more treatment facilities for public patients. That is precisely the situation regarding——

Deputy Eamon Gilmore

That is not precise at all.

The Taoiseach

That is precise. That is precisely where it is.

Deputy Eamon Gilmore

The Taoiseach did not answer the question.

The Taoiseach

The Deputy was suggesting that nothing is happening.

Deputy Eamon Gilmore

The Taoiseach can do better than that.

The Taoiseach

I have outlined factually what the situation is.

Deputy Brendan Howlin

Where are the beds?

Deputy Eamon Gilmore

He should answer the questions instead of playing for time.

The Taoiseach

He asked me to outline the issues. I have brought him up to date on where the issues are.

Deputy Eamon Gilmore

The Taoiseach was befuddling the House with his script.

The Taoiseach

I have given the facts of the situation.

Deputy Eamon Gilmore

It was a very poor response.

The Taoiseach

The Deputy was trying to suggest that nothing is going on.

Deputy Jim O’Keeffe

The Government is not prepared to help 12 year old girls.

Deputy Pádraic McCormack

It was a filibuster.