Confidence in the Minister for Health: Motion [Private Members]

I move:

That Dáil Éireann has no confidence in the Minister for Health, James Reilly T.D., because of his inability to deliver on his budget commitments which were based on false and misleading targets in many areas that were never achievable or implementable due to his lack of governance, resulting in more chaos across the health service which will directly impact on patients because of more frontline services being cut, extra bed closures, and more cuts to social support services to the disabled and elderly.

I do not particularly like tabling motions of no confidence in Ministers. Over the years, I have seen them get very personalised, sometimes deflecting from the reality of what a motion of no confidence is trying to achieve. I do not expect theatrics or drama tomorrow night, with Deputies crossing the floor to support our motion of no confidence in Deputy James Reilly, but I would be failing in my duty as an Opposition Deputy not to highlight his failings during his tenure as Minister for Health.

The Minister is no longer on the back of a truck in some rural town promising the people the sun, moon and stars. He is the Minister for Health and he has a responsibility. His actions and deeds to date have indicated that the majority of people in this House do not have confidence in him to carry out his duties. Since the Minister was appointed in 2011, we have had dysfunction and chaos reigning in the Department of Health. The HSE under his stewardship is being dismantled effectively and slowly so it is incapable of delivering the health service the people expect.

I want to keep this to the points of principle and have a fair debate on what this motion of no confidence is about: highlighting the failings of the Minister for Health in addressing the serious challenges the health service will face in the months and years ahead. The Minister came to power saying he had a mandate for reform and for changing how health services are delivered. Unfortunately, that mandate was sought under false pretences. It was sought using promises to people in Roscommon that the accident and emergency department would remain open and using promises to people in Monaghan and the north east that a new hospital would be built before there was any downgrading of services in Navan, Drogheda or Dundalk. It was sought using promises to the people of Cork that orthopaedic services would not be moved from St. Mary's Hospital and that the Minister would cut consultants' pay and abolish prescription charges. Those are just a few of the promises the Minister made, and I am sure as time goes on that many more of those commitments made on the backs of trucks throughout the country will come to light.

Clearly now, however, we face chaos and crisis in the Department of Health and the health service in general. This time last year, the Minister started running around the corridors of power telling everyone and anyone who would listen that we faced doomsday if he did not get his way when it came to delivering a budget for the health services for 2012. He put fear into his colleagues but at the end of the day he did not have the support of Cabinet to bring forward a budget that would be sustainable. The budget in December 2011 for this year was dishonest at the very least. He cobbled a budget together, with figures and statistics, savings that could be achieved, legislation that would introduce price referencing, generic substitution, the charging of private insurers for the full cost of public beds and the reduction of agency costs, but none of this has happened. As long ago as last March, the Minister was warned by the then CEO of the HSE, Cathal Magee, that the budget he had delivered was no longer sustainable. The Minister did not listen and we now have a situation where only a couple of weeks ago, because of his incompetence and inability to deliver and manage a budget, there were people outside Government Buildings protesting because their personal assistants were being withdrawn. Home help hours and home care packages were being withdrawn.

That is the context for this motion of no confidence. I do not do it lightly. Our party thought about this long and hard. We would be failing in our duty to highlight the Minister's failings and the damage and the impact his inability to manage the health service and the reforms he proposed are having on people.

There are two Ministers of State in the Department of Health, Deputies Róisín Shortall and Kathleen Lynch. This evening or tomorrow they will come in and swear allegiance to the Minister and promise they have a working relationship with him. It is quite evident that there is bedlam in the Department and no functioning working relationship between the Minister and the Ministers of State. We are unsure if the Minister delegated functions to the Ministers of State and gave them specific areas of responsibility. A report by Sarah McInerney in The Sunday Times was headlined "Reilly and Shortall's fractious working relationship revealed in a series of angry letters". It is quite amazing this is happening in the Department of Health when the Minister has promised there will be reform, with structures being put in place to streamline the health service.

One of the basic promises the Minister made related to primary health care and its roll-out. The Minister of State who was meant to be responsible stated clearly she had no responsibility in this area and that the Minister was undermining her budgets by taking money from ring-fenced budgets without even informing her. Unless these letters are figments of someone's imagination, they show that at the heart of the decision-making process in the Department of Health, there has been a complete breakdown of trust between the Minister and the Minister of State, Deputy Shortall, and probably the other Minister of State, Deputy Kathleen Lynch. As recently as a number of days ago, the Minister of State with responsibility for mental health stated there would be no reduction in her budgets, but the Minister had already raided that budget to fund the deficit evident in the broader health services. The Minister entered office with great fanfare and promise, saying he would transform health services. Unfortunately to date, there has been nothing but dysfunction and chaos reigning in the Department itself, which has percolated down into the HSE.

I find it bizarre that the Minister was appointed 18 months ago and one of his first major announcements was that he would get rid of the 50 cent prescription charge. Some time later he rowed back on that decision. He then arrived at HSE headquarters like Wyatt Earp at the OK Corral, or perhaps in this case like Doc Holliday, to sack the board and fill it with his own appointees and Department of Health officials. That is fine and the Minister has said he now has control of the HSE, but as recently as two weeks ago, when the health cuts were made, the Minister said they were not sanctioned by Government, that they were a HSE decision and that he would overrule them after the backbenchers got a little tetchy but, more importantly, when he saw for himself outside Government Buildings the misery and angst he was causing to many of the most vulnerable in our society.

How could the Minister even contemplate sanctioning the removal of personal assistants, home care packages and home helps in the context of a €14.3 billion budget? Why did he decide those would be the first areas he would cut to rein in a deficit he should have reined in months ago when he was warned about it by the former CEO of the HSE and by Members on this side of the House? Every time we raised that, we were shouted down for scaremongering and trying to whip up fear and anger among the public. We were not. We were following what was happening and the sad reality is that last June, the former CEO put his hands up in the Committee of Public Accounts and said the budget and figures presented to the Dáil were no longer achievable and were utterly unsustainable.

Even at that late stage, five months into the year, the Minister still refused to act. The Minister for Public Expenditure and Reform implored the Minister to get his house in order and the Minister of State, Deputy Shortall, was writing letters that highlighted that she was even willing at that late stage to intervene in the discussions on generic drugs and price referencing to bring about negotiations that would save some money in 2012. The Minister, however, put his head in the sand.

While the Minister talks a great game of reform and delivery of better health services, his decisions last week and the week before that attacked the most vulnerable in our society were the most distasteful things I have seen from this Government so far.

That is the reason we decided to table a motion of no confidence in him and not because of his other difficulties. I acknowledge he may be distracted in other areas. Clearly, he sanctioned the decision and then there was the famous U-turn that was not a U-turn with the Taoiseach saying he was courageous to change his mind. It was either a U-turn or he sanctioned the cuts himself. I would like clarity on who is in charge because last year-----

The Deputy should remember his Government brought the country to bankruptcy and signed the country up to the troika deal. I thank Fianna Fáil for the programme of austerity.

Deputy Kelleher without interruption, please.

I asked the Minister at a committee meeting in June when the chief executive officer and senior HSE officials were present who was in charge of the budget and, with great gusto, he rolled up his sleeves and said, "I am in charge; I am responsible and I accept full responsibility for every decision that the HSE makes". However, a few days ago, senior HSE officials were wheeled out to give the bad news. The Minister is removing himself from positions of responsibility. He went AWOL for a number of days until he was eventually flushed out and had to make the U-turn and we witnessed what happened after that. It was described by the Taoiseach as a courageous, brave decision. The Minister made a lousy, mean decision in the first place in the context of attacking the most vulnerable people in our society.

Fianna Fáil caused it all.

That is real in-depth analysis.

Let us be clear about the Government's grand plans for universal health insurance, free GP care and universal primary care. If those who need personal assistants to undertake basic functions and home helps and people who depend on home care packages have to fund his reforms and his inability to run the health service, he should go tonight. It is distasteful that people had to protest outside Government Buildings to force a U-turn on his decisions.

Fianna Fáil Members have short memories. We will have to roll out a new programme of amnesia care.

While we will have plenty of pledges of loyalty from Labour Party and Fine Gael backbenchers, the Minister does not even enjoy confidence among his Cabinet colleagues. Quite clearly, they will not express confidence in public. The Minister for Social Protection was asked on numerous occasions during radio interviews whether she had full confidence in him and she failed to answer the question and express full confidence in him. The Ministers of State, Deputies O'Sullivan and Shortall, and others have also said publicly they have concerns and they were silent in expressing confidence in him.

The Minister came into office with a lot of fanfare and promise. He traipsed the country promising the sun, moon and stars to people. He is no longer on the back of a truck as an Opposition Deputy. His actions and deeds have an impact on people's lives and his inability to work with Ministers and to bring in a proper, sustainable budget has had a huge impact on their lives. Many people think the cuts have been reversed but that is not the case. There was a round of stealth cuts prior to the September announcement and this is having a major impact on people on a daily basis.

I would like clarity on the funding of primary care because the Ministers of State at the Department are saying their budgets have not been raided but, at the same time, the Minister announced, without even discussing it with them, that mental health and primary care funding would be used to plug the deficit.

The Deputy should check that line out.

If the Minister of State wants to contradict Deputy Shortall, the Minister of State at the Department of Health, he had better read the report in The Sunday Times and the letters on the Minister for Health's desk.

Paper never refuses ink. The Deputy has gone over time.

The Minister of State will have his time and he can pledge full loyalty to the inability of the Minister for Health to manage this important service for the people of this country. He will be promised full support by everybody but, behind him, many backbenchers have lost faith in him.

I wish to share time with Deputy Mattie McGrath.

I second the motion. In doing so, I bear the Minister no ill will. I am contributing to the debate on behalf of the Fianna Fáil Party but also in recognition of the mess the Government has made in recent days and weeks of the delivery of health services in this country. I do not want to personalise this debate and it should not be personalised as being entirely the Minister's fault. I can best speak about what happens in the constituency I represent. I would like to take us back two years prior to the election.

The troika sneaked in two years ago.

I will be happy to deal with issues the Deputy has in due course. The Minister and Taoiseach, who was then Leader of the Opposition, visited County Clare and made firm commitments regarding the delivery of health services in the county. The Taoiseach talked about the retention of medical and cardiac services at Ennis General Hospital but, in recent weeks, the HSE recognised that they will not be maintained. The best the Minister has been able to do is provide two local Fine Gael Deputies with a firm letter saying no decision has yet been taken while our Labour Party constituency colleague has said he is aware that the medical services the Taoiseach promised would be retained will be taken from Ennis General Hospital and the cardiac services that have been part of the service delivery mix will be taken in due course, although not immediately.

What has changed significantly in the delivery of health services that requires the Minister to change the position he adopted prior to the election? As far as I am concerned, two things have changed. First, he has become Minister and the Leader of the Opposition is now the Taoiseach and, second, the HSE has been abolished by him. An effort is still being made by his backbenchers when they go on local radio and comment in the local newspaper to suggest the big, bad HSE is responsible for all of this. My colleague has outlined the position the Minister took and it is well known he forced out the chief executive officer of the HSE because he did not like what he was saying. He got rid of the corporate governance that existed, including the independent board and chairperson, giving himself effective control. It is hardly then fair that he should dump on the front line managers and staff delivering our health services and suggest that they are foisting these dreadful decisions on the people at large.

I was part of an Administration that had to accept that services at Ennis hospital had to be moved through the reconfiguration process.

Fair play to the Deputy; he defended them.

I did because they were in the best interests of patient safety. However, I never hid behind the HSE. I never said, "We do not have the money and someone else caused the problem". I stood up unfettered and put the change forward because I thought it was the right thing to do.

Fianna Fáil caused the problem.

Will the Minister do the same? Will he give Government backbenchers the wherewithal to explain the tough decisions that have to be taken and to say it is not a budgetary issue if that is the case and if services have to be reduced in a particular area, that this is being done from a patient safety point of view or in the best interests of the patient? If that is not the case and it does not stand up to the clinical view of doctors, the Minister should say it is a budgetary issue and that he has prioritised some other aspect of spending or that other areas of public expenditure are more important to his Administration than the services he is reducing in particular hospitals.

However, he should not try - as has his colleague sitting beside him - to hide behind the excuse that someone else caused all these problems and the Government is there to clear it up. The Minister still has a commitment to deliver an effective and required health service to the people. The Minister is now making these choices, which are not being made by people who are independent of the political system. The Minister has accepted control and is taking it.

The Minister should also explain a couple of points. When in opposition, his party referred negatively to the reconfiguration process, particularly in respect of the removal of acute surgery from smaller hospitals and its centralisation in the tertiary and main hospitals. As part of that negative political campaign, the Minister's party supported certain catch cries along the lines that, in the case of Ennis General Hospital, were such services removed and were the bypass protocols put in place, 20 people per year would die. The Minister's back-bench colleagues put posters in their windows advertising that fact. The Minister should answer a couple of questions in respect of that particular campaign. If there was truth or validity to such arguments, then 33 people have died in the constituency I represent since the Minister took office. What has the Minister done to correct this and to row back on the decisions that led to those deaths? I do not believe that 33 people have died and I do not believe it was an incorrect decision to reconfigure the surgical services. In copperfastening my view and given the benefit the Minister now has in sitting in the Department of Health as chief bottle washer, can he now confirm this was political rhetoric on the part of his colleagues? Can he confirm he fed into such rhetoric on a daily and weekly basis in this House? Can he confirm the then Leader of the Opposition and current Taoiseach fed into it when he visited County Clare and other counties, such as Roscommon, Sligo and so on, where he fanned the flames of fear in the minds of the constituents?

I object to the approach the Minister is taking for that reason. I saw a wry smile on the faces of the Minister and his colleagues when I first stated I did not bear him any ill will. I still do not but my support for a motion of no confidence in the Minister is aimed at the Government and the outrageous and cynical approach its parties took during the weeks and months before the election in an attempt to buy it. Moreover, they did not need to do so.

Deputy Dooley is losing it now.

The public had lost faith in the previous Government and was going to vote for the parties now in government anyway. However, they could not get over which of them would be Taoiseach, that is, whether it would be Deputy Kenny-----

Deputy Dooley is losing it.

There was no doubt about who would be leader.

Deputy Coonan now has Nenagh hospital to deal with and I note he made some important commitments in that regard. However, Fine Gael and the Labour Party were trying to outwit each other and on a daily basis, the ladder was not high enough for them to climb onto to wave the next slogan, regardless of what it did to undermine the good people who work in the health service. They simply could not resist the temptation to undermine what was and is a good service with problems and issues that must be resolved. However, they fanned that flame on a daily basis. They tried to hoodwink people and attempted to capitalise on people's genuine fears. In the case of many elderly people, people with sick children or people with a compromised immune system, their biggest worry is whether a bed will be available on the day on which they need it. In the Minister's case, he perceived that strain, exploited that weakness and captured a considerable amount of support on the back of it. It is right that the Minister now be made to answer for that in this House in an open and clear fashion. I do not like throwing political stuff over and back the floor of the Chamber. I want to stand up for the patients and people I represent. The Minister should explain to them how things have changed so dramatically in the intervening months and how, from the Minister's perspective, matters have so resolved themselves that it is not as bad as it might have seemed and does not have an impact on people's lives in the way he had presented it. I will wait to hear what the Minister has to say. I have never been afraid to stand in support of tough decisions and if he wishes to continue in that vein, I will have no problem in supporting him with a reconfiguration process that is centred on the delivery of a quality health care system with the patient placed front and centre. If this is a hard one to explain politically, I have a history in so doing.

I remind the Deputy that five minutes remain in the slot.

I went before the electorate and they accepted me for it. It now depends on the Minister and his backbenchers to show a small amount of backbone, to stop hiding behind the facts and to come out and tell the truth.

I thank Deputies Kelleher and Dooley for allowing me to share time this evening to speak on this motion, which I support wholeheartedly. Perhaps unlike the previous two speakers, who bear no animosity towards the Minister - neither do I - I have an issue with his handling of the HSE and the public, especially the underprivileged and those who are sick. Above all people in the world, the Minister, Deputy Reilly, who is a medical doctor of some renown-----

----- who has been trained and has taken the Hippocratic oath to protect people, must look into his conscience, if he has one, to see the pain, fear and trauma that is being inflicted on people. I refer to some who are in the services, others who cannot get in and in particular, to the elderly and the infirm. I also refer to the sickness that is being dispelled, with all the different kites that have been flown and all the threats that have been made, by people who are being well supported by their families, by the Carers Association and by some personal assistants and so on, who do tremendous work. Such people are happy, and as all Members are aware, being happy will make people healthier. However, they are all nervous now because they do not trust James Reilly.

Deputy Mattie McGrath voted for it and then he jumped ship.

They do not trust James Reilly.

Please refer to the Minister.

They gave up trusting the Chief Whip a long time ago. Why do they not trust James Reilly?

Please refer to the Minister.

I apologise. I of course refer to the Minister, Deputy Reilly. Many of his back-bench colleagues are sitting in the Chamber this evening to support him but many of them have told me quietly that he is new in the job, is not used to government and has only been in politics for a few years.


Who was it? Deputy Mattie McGrath should name them out. He has privilege.

The Deputy should withdraw that please.

I refer to when he undermines his own Ministers of State. Members had a discussion today on the Order of Business about how he will not delegate power to his own junior Ministers.

The Deputy has Dáil privilege and should name them.

What can one call him but a bully?

Please refer to the Minister.

In my classroom, that was called being a bully.

The Deputy has privilege and should name them.

Name who? They are all there.

Deputy Kehoe as well. I met a lot of people from County Wexford in a different country last week and they named him as well.

Had Deputy Mattie McGrath any bottle, he would name them.

The Minister promised so much.

The Deputy has no bottle.

He came to Clonmel - I know he was thinking of south Tipperary.

The Deputy does not have the bottle.

He ran through the hospital with such indecent haste that he nearly knocked people off the trolleys because he did not wish to meet or see them. Moreover, Deputy Tom Hayes, who is sitting behind the Minister, and I were to have this famous meeting with him on the conclusion of his visit. However, he jumped into his car and fled.

On a point of clarification-----

Please. Through the Chair.

Cromwell did not run as fast from Tipperary as did the Minister.

No, he went over the border. He has his stately mansion in Moneygall and his tax-free breaks.

On a point of order-----

He has a nursing home.

On a point of order.

A Deputy

Deputy Mattie McGrath has the floor.

Sorry, Deputy Hayes, resume your seat. The Deputy has two minutes left.

I have a point of order.

Two minutes remain to Deputy Mattie McGrath.

The Leas-Cheann Comhairle should add two minutes. Could the Deputy please-----

On a point of order-----

If the Deputy-----

What point of order? The Deputy is wasting time.

I must make a clarification.

I will give the Deputy a chance at the end of this.

If the Deputy will allow me, by sitting for one minute-----

I will stay standing as well. I will never stand for a Fine Gaeler. I will stand up to the Deputy any day of the week. Fine Gael promised everything and delivered nothing. It was the same way back in the 1920s. Deputy Tom Hayes is taking his time.

I wish to put on the record of the House-----

Please, very quickly and briefly.

----- that South Tipperary General Hospital was being closed down prior to the general election. However, a new Minister, Deputy Reilly took office and now we in south Tipperary have services enjoyed by no other county.

Deputy Mattie McGrath should answer that.

Deputy, please resume your seat. Three minutes remain.

He ran through it like a dose of flu and left the bugs behind him.

The Deputy should explain that.

Deputy, through the Chair.

That is total nonsense. I want to correct that fallacy, which the Deputy probably dreamt in a dream, at the think-in in Castlebar or up Croagh Patrick or wherever else he went. While I do not know where he went, the Deputy should say a few more prayers and should return to meet the people in south Tipperary who are ringing him day and night. Members know this but the Deputy is hiding behind whatnot.

This is Ballymagash stuff.

The problem is not with the Government but with the Minister, Deputy Reilly. He does not have time to deal with the health portfolio because he is too busy fighting the wars on his property portfolio.

The Deputy is too busy collecting the fivers.

That is the fact. Whether it is a nursing home in Carrick-on-Suir in which he has a share and which, incidentally, HIQA forgot to visit for three years-----

Deputy, we are not personalising the debate.

Deputy Mattie McGrath has his own problems.

He should give back the fivers.

Today, it was revealed he did not pay the architects who designed it. How could it be right, whether it is a portfolio in Offaly or whether it is all the different portfolios he has in Dublin? He does not have time to look after the ordinary people.

I ask the Deputy to resume his seat. Deputy Mattie McGrath has one minute left and I do not want any more personalised comments. I want order, please.

The Deputy is an absolute disgrace.

He does not have time to look after the people, only attack the front line services in St. Anthony's, St. Patrick's, South Tipperary General Hospital and many others.

The Deputy is a disgrace.

Mental health patients were told they were to go to Nenagh and now they are ending up in Ennis.

The Deputy is a disgrace.

I ask the Deputy to conclude his remarks in order to allow Deputy McConalogue to speak.

The Minister is peddling mistruths - he simply does not have time.

The Deputy is a disgrace to politics.

I ask the Taoiseach to relieve the Minister of his duties for the moment in order to allow him to sort out his business affairs and to try to ensure that HIQA is fair so that when it comes to Carrick-on-Suir, it visits every nursing home and does not pick one over another.

The Deputy is out of order completely.

The Deputy's time is up. I call Deputy McConalogue.

It could not be that my time is up - they interrupted me with their shouting.

The Deputy is a disgrace.

I call Deputy McConalogue.

It is no wonder politics is in the gutter because of the likes of Deputy Mattie McGrath.

Minister, please. I call Deputy McConalogue.

I support Deputy Kelleher in introducing this crucial motion. I do not wish in any way to personalise this because that is not what the public is looking for, nor is it what any of us in this House wishes to do. Health at any time is one of the most essential services to which citizens need access. At a time when we are facing cuts in our budget the Government's number one priority must be to ensure that services are protected. Up to 18 months ago the Minister was on that side of the House as the Opposition spokesperson on health. He talked the talk in terms of what he would do if he became Minister. Along with his now Government colleagues, he made several promises about what they would do if the public elected them to office. Memorably during the general election, the Taoiseach stood in front of a campaign meeting on a street in Roscommon and promised that, should he be elected to office, there would be no change in the status of the emergency department in that town's hospital. We have seen where that promise has gone. We have also seen what has happened to the stance the Minister held when in opposition.

The Fine Gael Party promised universal health insurance were it elected to office. Instead, 55,000 people gave up private health insurance last year and are now dependent totally on the public health system. Instead of the reforms the Minister promised, with money following the patient, hospitals across the country are being asked to make cuts regardless of how efficient they are or the number of treatments they carry out.

On coming into office, one of the Minister's first actions was to abolish the HSE board. That was followed by the CEO moving on and being replaced by someone of the Minister's choosing. One of the problems with the lack of progress in reform of the health service is, unfortunately, the Minister's leadership. That has never been more apparent than when some of his ministerial colleagues, including his departmental colleagues, refused to express confidence in him. A year and a half into government and with three and a half years left in the most crucial portfolio, colleagues are failing to express the faith in him that he requires in order to carry out the types of reforms that are needed. Unfortunately, the only option is this motion of no confidence and for the Minister to consider whether he will be in a position to continue in this role and deliver the reform and change that is needed.

The HSE was asked to put together a service plan for this year which we did not see until the end of January. Then the HSE regions were asked to put together regional health plans which were not signed off until the middle of March. How are we supposed to be able to plan a health service for a year when the plans for the service itself are not agreed until half way through the year? When the Minister prepared the budget in December he premised it on many things which he was then unable to achieve and did not follow through on. The was supposed to be a saving of €124 million through a new pricing agreement with the industry. Unfortunately, in June, this was described as unachievable by the outgoing HSE CEO, Mr. Cathal Magee.

It was also assumed that there would be an additional €140 million saving from increased private income but that assumption was described as undeliverable by Mr. Cathal Magee in June. Reducing agency costs by 50% was a further target which was again described as unrealistic by the former HSE CEO. Given that the budget introduced by the Minister in December was based on figures that were unachievable, by half way through the year the HSE was facing an end-of-year deficit of €500 million. What was the Minister's reaction to that? Instead of taking leadership of the HSE, the board of which he had abolished, the Minister's reaction was to send the HSE's officers out to announce cuts a few weeks ago while he went into hiding as opposed to taking responsibility. Unfortunately, that was a reflection of our health policy in the past year and a half under the Minister's stewardship. This was followed by members of the Government coming out and saying they were unaware of the cuts and in many instances refusing to express confidence in the Minister for Health. How does he plan to continue to provide the leadership to deliver the reform we require given the situation in which he finds himself now?

I would like to outline the type of reform that is required in the region I know best and, in particular, in the hospital I know best, Letterkenny General Hospital, where we have seen real examples of the Minister's failure to introduce a policy whereby money follows the patient. Its spending has gone from €105 million two years ago to a budget as required by the Minister of €92 million this year. That takes no account of the number of treatments carried out or how efficient the hospital is or the impact any cuts the Minister might bring in will have on services. However, other hospitals, which might not end up being nearly as efficient, are being asked to cut their budgets by similar amounts. These are hospitals that may have capacity. No realistic review of what is being delivered for the money being put into the service is being carried out. There is no correlation between the funding cuts requested by the Minister and the treatments that may be delivered on the ground.

The Minister took over leadership of the HSE and got rid of the board which was responsible for it in the past. Yet he seems to have lost the ability to lead and the confidence of his colleagues to do the very important job of delivering real health service reform.

It is time the Minister reconsidered his position and that the Government reconsidered what type of leadership is needed to deliver the type of health service required by the people.

The next speaker is the Minister for Health, Deputy Reilly, whom I understand is sharing time with Deputies Buttimer, Rabbitte, White, Corcoran-Kennedy and Walsh. The Minister has 20 minutes and each of the other Deputies has two minutes.

I move amendment No. 2:

To delete all words after “Dáil Éireann” and substitute the following:

"commends the Minister for Health, James Reilly T.D., for the progress to date on the reform of our health services and for the effective manner in which he is managing resources in a difficult budgetary and economic environment, placing the concerns of patients at the centre of the healthcare system;

endorses the specific measures that the Minister has taken to improve the performance of the service delivery system and to strengthen the overall governance and accountability of the system; and

supports the Minister in his determination to move towards a health system that provides access based on need rather than income, underpinned by a strengthened primary care sector, a restructured hospital sector and a more transparent ‘money follows the patient’ system of funding that will be supported ultimately by Universal Health Insurance."

This motion could be described as political opportunism because that is exactly what it is.

The Minister knows all about that.

He wrote the book.

It is the empty noise of a party that ran out of ideas and idealism a long time ago, a party that has damaged each and every family in this country because of the economic collapse over which it presided, a party that sold our nation down the river.

It is a bit ironic to be charged with poor governance by a party that left this Government with the biggest budget deficit in our history; that, through collective incompetency, lost Ireland its economic sovereignty and damaged our credibility and international reputation; that gave new meaning to the brown envelope; and seriously discredited our system of government.

Deputies Kelleher and McConalogue have bizarrely promoted the idea that I went into hiding when the cuts were announced. I was on television the very next day-----

Sitting on it, I would say.

-----reassuring people that they were not going to lose service but that reassurance was lost in all the noise from the Opposition-----

From the Labour Party. Deputy Keaveney is not a member of Fianna Fáil.

-----who went on to cause so much worry that people felt it necessary to sit outside Dáil Éireann overnight. I am truly sorry that I was not able to communicate clearly to them the fact that they would not lose their service.

Why did the Minister not go out to them?

A number of people have said that I abolished the HSE board and the HSE. First, the board is to be abolished but is not yet abolished and, second, the HSE has not been abolished.

The Minister is looking for a fall-guy.

Deputy Dooley has contended that 33 people have died because reconfiguration did not take place. I would be happy if he could provide me with the details of what happened.

The Minister said they would die.

On a point of clarification-----

The Minister has misrepresented what I said.

I am going to leave that now.


A Leas-Cheann Comhairle-----

I was told to sit down earlier.

Where is Deputy Tom Hayes now.

Deputies, please. This is a very limited debate.

I am not going to spend the evening-----

The Minister has asked for clarification.

The Deputy can send it on to him. He may not do so now.

The Leas-Cheann Comhairle is not being equal.

Deputy Dooley can clarify the matter in his own time.

The Minister has asked for clarification.

How come I was stopped and told to sit down?

Deputy Dooley is sitting down.

Why was I told to sit down? We should have equal play here.

Could we hear the Minister?

On a point of order-----

I will allow a point of order but not a speech.

On a point of order, am I correct in saying that if the Minister in the course of his contribution requests a speaker to provide information and gives way that person can provide the information? Is that not within the rules of the House?

That is not a point of order. If the Minister wants clarification I presume the Deputy can provide it later but not now.

I am ready to do so now.

No. The Deputy has already spoken.

A Leas-Cheann Comhairle, I presume I will be allowed the extra minute speaking time which the Opposition has taken up.

I call the Minister.

This is totally unfair.

I am not going to continue to engage here tonight in the normal political rhetoric that is the style across the way.

The Minister set it up.

Rather I am going to deal in facts and measurable outcomes.

That is a change.

I would like to say at this stage - to paraphrase Bill Clinton - what Fianna Fáil is giving out about is the speed with which this Government is clearing up the mess it made.


Hear, hear.


Deputy Martin, who is not here tonight, is the prime designer in chief of this mess. Let us look at what happened. The health budget grew in the 14 years of Fianna Fáil coalition Governments by more than 320%, from €3.6 billion to €15 billion. During his time as Minister for Health, Deputy Martin spent €13.8 million on management consultancy.

Who negotiated for the GPs?

With all that advice and increased funding one could have expected balanced budgets. Instead, what we find is that during his tenure as Minister for Health, Deputy Martin still managed to over-shoot his departmental budget and had to be bailed out with supplementary budgets amounting to €664 million. Between 1997 and 2010, Fianna Fáil's period in office, €2.2 billion was spent on supplementary estimates. Deputy Martin as health Minister during the best economic times could not control the health spend yet he has the nerve to criticise those who have controlled it in the worst of economic times.

How does the Minister define "control?"

The challenges besetting our health system are a direct result of Deputy Martin's fatally flawed budgetary and service planning processes.

That is what Deputy Shortall said about the Minister.

A recent external independent review highlighted that the governance and control framework in the HSE lacks clarity, is not properly embedded and does not enable effective control to be exercised over voluntary providers. The financing and operating models are tied to antiquated health board structures and there are significant inconsistencies in approaches to analyses and financial performance management and data collection.

Let us not forget that Deputy Martin was the designer in chief of a new health service where he created unaffordable, unsustainable and grossly inefficient bureaucracy. Instead of getting the normal efficiencies that one gets from merging 11 different companies and reducing overheads, we got all the idiosyncratic inefficiencies of 11 different health boards. That still haunts us to this day-----

This Government is well haunted at this stage.

-----in terms of financial reporting mechanisms, different ways of counting things, different ways of coding things, information that is nigh on impossible to analyse.

All the focus was on inputs instead of looking for outputs and examining outcomes for patients and applying best practise. I have put in place a financial improvement programme and new performance management arrangements are in train. The new finance improvement programme will transform the way financial management is handled across the health system working in partnership with all in the sector, supporting capability and capacity building.

Patients, not inputs or money, are the priority.

Patients and what happens to them is what really matters.

What about the carers?

I have often said that no matter how elegant the design or how eloquently it is delivered, if it does not improve patient outcomes it is for nought.

When I became Minister for Health I found systems that do not communicate with each other; no analysis of problems - merely descriptions of them---


-----and a history whereby my predecessors where informed of budget overruns. It was all about lamh amach agus airgead isteach---

The Minister knows all about that.

-----not why have we an overrun and what are we going to do about it. Deputy McGrath was offered an opportunity by the Chief Whip to name the people he says do not support us.

No, Minister please.

The Deputy used the opportunity and privilege of the House to make allegations against me.

The Minister should look behind him.


The Deputy does not have the courage of his convictions.


Excuse me, I would like to hear the Minister.

The Minister has the floor.


I am primarily a doctor, a late-comer to politics but I do know one thing.

I have always said that.

Can Deputies stop interrupting?

Deputies please, there is no need for this. Deputies are completely out of order.

There is an old maxim which Deputy Mattie McGrath should remember: "Empty vessels make the most noise."


Hear, hear.

The Minister is making a lot of noise.

As a doctor, one does not only look at the signs and symptoms, one must treat the cause of the problem. One has to analyse the cause and must have one's diagnosis before one starts treatment. That is what we have done. The special delivery unit headed up by Dr. Martin Connor analysed why we have overcrowding in our emergency departments, in particular every January. Every hospital is different. We are successfully tackling the causes of overcrowding on a site-by-site basis.

The Minister promised there would be no more waiting on trolleys.

We did not allow that to happen this year. We did not have 569 patients on trolleys in January 2011, which is a little more than 18 months ago.

The special delivery unit in conjunction with the clinical programmes and front line staff knew what the diagnosis was and prescribed the treatment between them and the consequence of that today is that despite €1.75 billion being taken out of the system and another €750 million being taken out of it this year, we have 20% fewer people lying on trolleys, over 13,000 fewer people so far this year. That is a fact and something that is measurable. Those are INMO figures.

To guarantee the integrity of the count, we accept the figures of the INMO, and we go further, we measure it three times a day and now we can predict what is going to happen and take action.

That is something that was not possible before and something which the Members opposite and their Government failed to do in ten years.

At this point, I would like to express my appreciation to Dr. Barry White for his considerable efforts in his term as a director of the clinical care programmes. He is now returning to his clinical consultant post but I am pleased to announce that he will continue to work closely with me and my Department. The clinical programmes have three main objectives - to improve the quality of care, to improve access and to improve cost-effectiveness. They will do this by modernising the way hospital services are provided across a wide range of clinical areas.

Let us look at what we have done since the Government came to power a mere 18 months ago. There has been a 20.6% year on year reduction in the number of patients waiting on trolleys. There has been a reduction from an all-time high of 569 patients on trolleys on 5 January 2011 to 139 on 7 September 2012, representing a 75% reduction. Overall surgical waiting list numbers have decreased in the last year by 7%, while every time band has seen a substantial reduction with those waiting over 12 months down by 85%, which the Taoiseach mentioned earlier today, those waiting over nine months down by 63%, and those waiting over three months down by 18%.

The Health Service (Governance) Bill 2012, which has been published, provides for the abolition of the HSE board and its replacement with a new directorate and governance structures. A director general designate has been appointed and is already taking action to reform the system. The Health (Pricing and Supply of Medical Goods) Bill 2012 is before the Seanad and will provide for reference pricing and reductions in generic drug prices. Restrictions on GPs wishing to become contractors under the GMS have been abolished. A programme for the development of 20 primary care centres, using public private partnerships, has been established. The development of chronic disease management programmes are in train, particularly for the management of diabetes, which is at an advanced stage.

I have been particularly concerned about the outcomes for stroke victims and we now have a programme to save lives and improve the quality of life for patients. When fully implemented we are confident it will save one life per week and avoid serious disability for three more people every week.

The new 40 bed facility for cystic fibrosis patients at St. Vincent's University Hospital has opened removing the dread of cross infection from this most vulnerable group of patients.

Ongoing progress is being made in introducing new models of care across all service delivery areas to treat patients at the lowest level of complexity and provide quality services at the lowest cost. The restructuring of the hospital sector has commenced and two pilot hospital groups have been established at Limerick and Galway.

Specific work has been undertaken to enable the introduction of "money follows the patient" funding methodology. This means a patient-centred service. If no patient is treated, no money will be paid. This saved €6m in expenditure on orthopaedic services alone.

Complex negotiations are progressing with the Irish Pharmaceutical Healthcare Association to further reduce the price of certain medicines and they will conclude shortly. Ongoing progress has been made in mental health services in the implementation of A Vision for Change, with particular improvements in child and adolescent mental health services. Advances have been made in the care of older people with over 22,000 people in receipt of financial support for long-term nursing home care. A catch up human papilloma virus, HPV, vaccination programme for girls in sixth year of secondary school has been introduced and 48,000 children have been vaccinated to date.

An improved risk equalisation scheme for private health insurance will take effect from 1 January 2013. This will be central to the effective working of a community rated health insurance market. Some €125 million will be collected from the health insurance system by the year end following intensive discussions.

The clinical programmes freed up 70,000 bed days last year. That is a real saving of €63 million. The figure in that respect will be even greater this year - it will be in the region of €90 million. A new clinical programme is being rolled out currently in regard to transitional care for older people in order that those who are in this category will be admitted to a ward, will have their medical problems dealt with in the first 48 hours and will commence their rehabilitation immediately, moving on to an intermediate facility if their rehabilitation requires that and moving into a transitional facility if they need long-term care but the location of their choice is not available to them.

Real people have benefited from these achievements and the Government's reform programme. These are real people. It could be your daughter, my brother, his sister, her mother. There are still too many people waiting and we want to go further and we will.

We now have for the first time, de facto, 24-7 rostering, meaning that consultants will be rostered five days out of every seven, including Saturdays and Sundays. They will be available at night. This will further shorten the stay of patients as we have senior decision makers available 24 hours a day and I believe this will also result in fewer tests saving more money as well. It will also reduce the need for non-consultant hospital doctor overtime. It will also save us some 220,000 bed days at €900 a day. All this will save, conservatively, €200 million in the running of our health services but, most importantly, it will improve the quality of care available to our citizens and will mean that more patients can be treated more quickly. That is the one thing I undertook to do, to change a self-serving system back to a patient-centred service.

I wish to state that in excess of €310 million will be spent on home help and home care packages this year. I want to assure the House that those in need will continue to receive the required service.

We have travelled along way a long that road but we have a long way to go. The new consultant arrangements are an important step on that road and I want to thank all those involved for the leadership they have shown in this regard. I have to thank all the clinicians, managers and support staff for their hard work in ensuring that all this has been possible despite the fact that 4,000 people have left the health service in the last year and despite the fact that we are operating under much reduced budgets. To all those who said to us last January and February that the health service would collapse in chaos-----

-----at the end of that month, not alone did we maintain a safe service, we have improved it as I outlined. As an Irishman I believe that what makes Ireland a great country is not the wonderful landscape, the rivers and the green fields but the people, their resilience, compassion and their capacity for innovation. I similarly believe the health service will be one of the best in the world because of the great people working in it. It is my honour and privilege to serve as Minister for Health and to be a part of this historic change in our health service - change that is for the benefit of all our citizens. I intend to continue in this role, to continue the reform and to always put the patient first. I commend the Government's amendment to the motion to the House.


Hear, hear.

I second the amendment to the motion. I ask Members to cast their minds back to the health committee a number of years ago when we discussed the Travers report when a certain Minister was asked what he knew or who was responsible and his line of response was "I had no responsibility; I was not responsible." That was Deputy Micheál Martin, the then Minister for Health. Tonight we contrast that response with a Minister, in whom I have confidence, who has commenced the process of reform and who is delivering a patient-centred and a patient-first health system.

The motion before us is a cynical political ploy by a party bankrupt and bereft of ideas and it ill behoves its members to come in here and speak on this after 14 years in government when they gleefully abandoned the Department of Health. They rubbed their hands and left the former Minister, Mary Harney, in there. They would not even take it on. They refused to go in there.

This motion, at its core, is about how we can bring reform to our political system and to our health system. Deputy Martin promised an end to the Punch and Judy politics but he has not stayed true to that line - he has abandoned it. His party abandoned it for the last 18 months and it abandoned it during the 14 years it was in government. The Galway tent and the friends act is over. There is a new politics.

This Minister will drive reform, and he will do so with the people who work diligently in our health service.

Does the Deputy believe that?

He does not believe that.

These are the people who, with this Minister, will show us that we have a health system that will be fit for purpose and that will not be in the hands of the vested interests.

Who told the Deputy that?

This is a Minister who has commenced the process of reform. The reform, as he said in his contribution, is evidenced in every item since he became Minister. I challenge the naysayers to look at what has been delivered under the auspices of the Croke Park agreement. Since last February we have not seen the end of the health system. There has been a reduction in the number of people on trolleys. We have seen more services being delivered.


We have not seen chaos in the city of Cork as alluded to by Deputy Micheál Martin last week, or Deputy Kelleher, because the figures in terms of reconfiguration were started by him. They proposed that treatments be removed from the orthopaedic hospital to the south infirmary. They moved BreastCheck from the south infirmary. They started that process, and they cannot hide behind the decisions any longer because they waved the flag. They wrote the prescriptions and they have now seen what happened in respect of that. The gentlemen opposite should get real about it because their policies have failed. Their ways did not work. They may have forgotten that their ways have bankrupted our country. They are the people who are the cause of where we are today, and they should never be allowed to forget that.


This Minister and this Government will put patients first, and that is what the health system must be about. It must be about the patient who goes in the door of the hospital. It is not about the money in one's pocket or the colour of one's political affiliation. It is about a Minister who will deliver, and if he does not deliver in four years we should have another debate about it but let us have the courage, for once in our lives, to take on the vested interests and the naysayers who have failed this country.

I am here to express my support for and my confidence in the Minister for Health and the huge challenge that he has been left by the outgoing Fianna Fáil Administration.

For more than ten years the people opposite failed in the best of times to deliver a quality health service. In times of plenty they had the unique distinction of making the situation worse. I cannot believe, having listened to all the pious clap-trap over the past number of months about Fianna Fáil not being interested in the old Punch and Judy politics or opposition for opposition's sake and that it will not play games, that its members can come in here with this codology, authored by the man who created the problem, the man who created the Health Service Executive, HSE. If I were Deputy Micheál Martin and I had done to this country what he did to this country, and to the health service in particular, I would crawl under a stone in the Burren and start to commune with nature for the rest of time I would be around. It is appalling. The Minister in his contribution quoted Bill Clinton to the Republicans when he said: "Remember. What you are complaining about is the speed that it takes us to clean up your mess." That is the situation that we have been left with.

We should look at the question of access for patients, which is the critical issue. We should look at the trolley count. We should look at the fact that today, 18 September, the trolley count is 223 trolleys. That is 223 trolleys too many but half of what the figure was last year, and a great deal less than half of the 569 that Mary Harney brought it to when she was propping up the Fianna Fáil Government that brought this country to the edge of the precipice and threatened us with ruin.

The Minister is attempting to deal with this challenge in terms of access for patient care, in terms of resources, and in terms of laying the foundation for a universal health insurance system in this country. He deserves support in that challenge and not the kind of hypocrisy-----

He should have a chat with the Minister of State, Deputy Shortall.

-----from the people who created the mess coming into this House on day one of the new term-----

Where is the Minister of State, Deputy Shortall?

-----with the same old codology about a motion of no confidence that they know has no prospect of success in this House.


I am very sorry, a Leas-Cheann Comhairle. I would have liked more time because I am only getting off the runway.

I am very happy to support the Government amendment expressing confidence in the Minister for Health. When one listens to this debate as I have done, like others, for the past hour one tries to work out the basis for the motion because if people-----

Ask the Minister of State, Deputy Shortall.

-----from the Fianna Fáil Party or anywhere else came in here and had objections or criticisms on policy grounds of what the Minister was doing I would take them seriously. I would have taken Deputy Kelleher seriously. I would have even taken Deputy Dooley seriously-----

I greatly appreciate that.

-----if he had come in here and set out the basis upon which, on policy grounds, he had objections to what the Minister for Health and the Government are doing. That has not occurred, not once.

The basis for the Fianna Fáil motion of no confidence in the Minister for Health, as far as I can define it, reduces itself to three objections.

We only have three hours.

One is in regard to the savings announcements that were made last week or the week before that Deputy Kelleher complains about, justifiably in some respects. It is not clear from him whether he has a difficulty with the announcements themselves or with the fact that it was clarified afterwards that some of those matters were not going ahead. He cannot make up his mind which it is but he wants to make that the basis of his attack here this evening.

The second, which is the aspect that is quite remarkable and which comes up repeatedly, and on which the Minister, Deputy Rabbitte, is absolutely right in regard to the approach taken by the Fianna Fáil Party, is that they want to re-run the election. The general election was lost spectacularly by the Fianna Fáil Party. It has nobody else to blame. It does not have the Minister, Deputy Reilly, on the back of a truck or anywhere else, to blame for the catastrophic loss by the Fianna Fáil Party of that election. There is no use trying to re-enact the election and claim that this, that or the other was said. Of course it is true. I will be honest in this House as a backbencher and strong supporter of this Government and say that not all of the commitments given in the course of the election have been possible to carry through as yet but this Government is keeping faith with the people.

How many bondholders were burned?

This Government is keeping faith in terms of what was said in the general election. This Government will bring about reform in the health service with no thanks and no support, which we understand and expect, from those on the opposite side. I support the Government amendment.

This motion by Fianna Fáil, and the Sinn Féin amendment, is a charade. The Fianna Fáil motion states that Dáil Éireann has no confidence in the Minister, Deputy Reilly, because of his inability to deliver on his budget commitments. That is a bit rich coming from Fianna Fáil, the party which, when in government, had Deputy Martin as Minister for Health and Children. He played a key role in establishing the HSE and allowed the HSE to develop the habit of obtaining more and more taxpayers' money by way of a supplementary budget each year. As the architects of the HSE it is no wonder Fianna Fáil Members are so committed to its retention. However, it is a disastrous legacy.

The abolition of the health boards diminished accountability because local and national public representatives are shut out from an oversight role. No effort was made to reform the health system to meet the needs of the modern world. The opportunities of the so-called Celtic tiger were squandered.

This is the party that led our country into a fiscal quagmire, aided and abetted by the Progressive Democrats, the Green Party and select Independents. The fact that we no longer have fiscal independence is due to their failed policies. Fianna Fáil bankrupted the State and surrendered Ireland's economic sovereignty to the troika. It signed up to a deal that now requires huge budget cuts in the Department of Health. They are now attacking the Minister, Deputy Reilly, who is genuinely trying to clean up the mess.

Sinn Féin's amendment refers to the Minister, Deputy Reilly, being inept but nothing could be further from the truth. This Government has been tasked with completely overhauling the way we deliver our health services and the Minister, in his short time as Minister for Health, can reflect already on several successes. Speakers have mentioned the fewer people on trolleys in the first six months of this year in comparison to last year since the establishment of the special delivery units even though there has been an increase in patient traffic. The new drugs reference pricing legislation is already in the Seanad. It will be law by October, and the Minister will be in a position to reduce the price of generic drugs, making annual savings of between €50 million and €60 million.

Consultants are often referred to as the linchpins of reform. A breakthrough was reached between hospital consultants and the HSE at the Labour Relations Commission last week. Major progress has been made in the areas of rostering and work practices, and by moving to a seven day rostering system the Minister estimates that we can save up to €200 million a year while better meeting the needs of patients.

I must call the Deputy's colleague, Deputy Walsh.

I welcome the opportunity to express my confidence in the Minister for Health. This debate, to which I have listened, has been described by some of the Members opposite as being important and crucial. Let us be very frank about it: this is nothing but an absolute waste of valuable Dáil time. The motion was tabled by a party that has, on occasion, complained about not having enough time to debate legislation. The motion is nothing but populist political opportunism on the part of Fianna Fáil. The irony that the motion is being brought forward by Fianna Fáil will not be lost on the people. It seems that it is the leader of the Fianna Fáil party who is driving this agenda and who announced that the motion would be tabled initially. It appears that, 18 months since the general election, the trauma of the drubbing that Fianna Fáil received is still having an effect on its members' memories.

Deputy Martin was the man who created the HSE and all the bureaucracy that surrounds that agency. Today the Taoiseach gave an example of bureaucracy in the HSE that he came across in recent days in his constituency. Deputy Martin was part of an Administration that brought this country to near penury. His complete mismanagement of the nation's finances and his complete incompetence at the Cabinet table are precisely the reasons Deputy Reilly, the current reforming Minister for Health, has been forced to introduce cuts of almost €1.75 billion since assuming office. Notwithstanding the budget cuts he must implement, he is actually achieving results. The Minister listed them himself and I will not repeat them because I do not have time. I would love to repeat what he said earlier.

It is not simply members of the Labour Party, Ministers or Fine Gael Deputies who are saying what I am saying; independently minded people are also saying it. People such as Mr. Liam Doran of the INO, whom one would not usually expect to endorse politicians, said in unambiguous language that the Minister is achieving far more with fewer resources. In my constituency in Galway, I have seen ample examples of what has been achieved. We now have an eminent professional in the field of health care at the helm of the Department of Health. He has devoted his entire working life to helping patients and working with them. He entered politics with the singular goal of improving a service he knows inside out. The measure of the support among both parties in government is such that their members are allowed only two minutes each in which to speak in this debate. I have complete confidence in the Minister and echo the sentiments expressed by my colleagues.

The Sinn Féin Deputies have no confidence in the Minister for Health, Deputy James Reilly, and we deplore the Government’s attacks on our public health services. We roundly reject its fundamentally flawed and inherited health policy. We will be voting accordingly at the end of this debate.

Ar dtús, molaim an leasú in ainmneacha na dTeachtaí ó Shinn Féin. Ní leor an rún ó Fhianna Fáil, páirtí a chur ciorraithe ar sheirbhísí sláinte i bhfeidhm nuair a bhí siad sa Rialtas. I commend the amendment in the name of the Sinn Féin Deputies. The motion in the name of the Fianna Fáil Deputies has no credibility. Fianna Fáil was the party that imposed cut after cut to the health services, closing not only services but effectively closing hospitals. I know this only too well.

This debate was prompted by the €130 million in further cuts announced by the HSE on 30 August. This reduction was on top of the over €750 million taken out of the health services in budget 2012. This followed a cut of €1 billion, taken from the health budget for 2011. Among the cuts announced on 30 August were further restrictions on overtime and the use of agency staff. Additional overtime and the hiring of agency staff were made necessary by the ongoing recruitment ban. Despite their vocal opposition to it prior to the general election, the Minister and his Fine Gael and Labour colleagues have not lifted that ban. This is a very important and central issue in our considerations. We warned that such cuts would compromise front-line services, and this is exactly what is happening now. That is the reality in which we are today.

The lead clinician in the department of anaesthesia at Our Lady of Lourdes Hospital, Drogheda, Dr. Michael Staunton, makes clear in a letter sent to the HSE in the past week that the cuts will have a very serious effect on the intensive care unit and operating theatres in his hospital. In both cases, services will be significantly reduced for patients. Dr. Staunton states with authority that, among the list of effects, the cuts may have the effect of "increased morbidity and mortality of critically ill patients". The cuts in the hospital in Drogheda will mean the closure of 16 inpatient beds, one operating theatre for five to six weeks, day ward beds at night and at weekends and one intensive care unit bed. They will mean reduced opening hours for the acute medical assessment unit and the closure of beds in Louth County Hospital, Dundalk, for clinically discharged patients from Our Lady of Lourdes Hospital. This is but one example of the impact of the further proposed cuts on one hospital. It is replicated at other hospitals in the north east and, undoubtedly, it will reveal itself in hospitals throughout the jurisdiction.

Our Lady of Lourdes Hospital is the main acute hospital in the north-east region, covering counties Louth, Meath, Cavan and Monaghan and also accepting many patients from Dublin North, the Minister's constituency. The implementation of the cuts would put the lives and health of people in the region at risk. I demand on behalf of all those who are and will be affected by these cuts that the Minister intervene and ensure the cuts are stopped, and stopped now. I refer to but one region but the reality of savage health cuts is replicated across all HSE regions. I warrant that what has been exposed in regard to the Louth-Meath hospital group will expose itself in a very short period in various HSE areas across the State.

Since and before the Minister took office, he made great play of his determination to take the reins in his own hands and take executive responsibility back to his office from the HSE. He legislated accordingly, which I supported and welcomed at the time because I believe this is how it should be. However, with respect, we must ask where the Minister was when the cuts amounting to €130 million were announced on 30 August. He left it to the HSE to be the bearer of bad news. He was nowhere to be seen on that day and he had to be smoked out of hiding to answer to the media and the public. What an announcement it was. One should make no mistake: home care packages and home help hours were cut. There were cuts in respect of agencies and overtime and no lifting of the recruitment ban. Personal assistance for the disabled was cut. It was truly appalling and the impact was incredible.

I commend the people with disabilities, who deserve to be recognised and commended tonight. They camped outside Government Buildings. It is terrible to think back on what they had to undertake. They demanded the lifting of the cuts affecting personal assistants. They secured what I can only describe, as generously as I can, as an apparent climb-down by the Government. We must wait and see how that works out in practice. It is not crystal-clear at all.

What I want to ask this Cabinet is how such a cruel cut was approved in the first place. Are we expected to believe that this was not approved directly by the Minister? Are we to believe that the detail of this major package of €130 million in further cuts in public health services did not cross his desk? If it did not cross his desk, the claim that he is a hands-on Minister who has taken the reins from the HSE is spurious. If he signed off on these cuts, he bears responsibility for causing distress to the most vulnerable of our citizens. That he must climb down in the space of but one week shows what can only be called chaotic management of our public health services.

Unquestionably, the Minister for Health, Deputy Reilly, and his Fine Gael Party and Labour Party Cabinet colleagues are plunging the health services into an ever deep crisis with the savage cuts being imposed. These are not the words of Opposition voices only or those shared with him privately by voices in the House. These are the views of lead clinicians at hospital sites the length and breadth of the country. This real and genuine concern is growing to angry proportions.

Incredibly, the Minister has claimed that the health cuts in budget 2012 did not lead to a loss of services despite the fact that hospital and nursing home beds have been closed and services reduced across the hospital system. Surely we all recognise the fact that existing home help, home care and personal assistant services are insufficient to meet current needs, yet they are to be reduced further. The HSE and the Government are also slashing the numbers of public nursing home beds and claiming that the priority is to keep older people living in their own homes. I have had some personal experience of this issue recently. It poses a dreadful challenge to families. The necessary level of support does not exist to achieve an objective that is shared across this House, namely, allowing older people in infirmity and suffering progressive deterioration, for example, from Alzheimer's disease and a range of other challenges, to stay in their own homes as they desire. This difficulty is presenting for many families the length and breadth of the country.

These supports are critical in our efforts to try to keep older people living in their own homes, yet approximately 300 public nursing home beds have been closed this year so far. It is estimated that 600 mostly older people are in hospital beds and ready to be discharged but awaiting non-existent care places. Some 2,400 public acute hospital beds are closed.

We had the further revelation in the past week that the promised provision of free general practitioner, GP, care to people on the long-term illness scheme may be delayed for a further 12 months. The extension of free GP care to all, beginning with people on the long-term illness scheme, was supposed to be a cornerstone of the Fine Gael-Labour parties' coalition health reforms. Free GP care for long-term illness patients was promised by the Minister for 2012. So much for his promises. Legal issues are being cited for the delay. If this is the case, it is incredible that it took more than a year in government for the alleged legal difficulty to come to light, given the fact that the commitment to start the roll-out of free GP was a Fine Gael Party and Labour Party promise from long before the February 2011 general election. Many will suspect that the alleged legal difficulty is a convenient excuse to cover a retreat brought about by the financial crisis in the health sector, a crisis worsened by the Government's policies. If there is a real legal difficulty, the whole basis of the promised reforms of the Minister and his coalition colleagues is in question and they must be challenged on their failure to provide a proper legislative foundation for those reforms.

The spending over-run in the health budget this year was utterly predictable because the amount of money cut from the health budget for 2012 was unsustainable. Some €750 million was taken out of health in the Fine Gael-Labour Government's 2012 budget.

The Deputy has just over three minutes remaining.

Some €1 billion was cut from health spending in 2011 and the Department of Health is referring to an overall reduction of €2 billion up to 2014. This is scary stuff.

The Fine Gael-Labour Government puts the diktats of the troika before the old, the sick and people with disabilities in Irish society. There is no other conclusion. Regularly, the Government points to the troika as a convenient crutch for the cuts with which the former is proceeding. The decision not to proceed with reversing these cuts rests with the Minister. How long will the Government continue to run our public health services into the ground? In tandem with our proposed motion of no confidence, I appeal to the Minister to come back from this point in everyone's interests.

As we are debating a motion in the name of the Fianna Fáil Party Deputies, it is well to point out that there is an Irish troika, namely, the troika of the Fine Gael, Labour and Fianna Fáil parties, which are as one in their support for the futile economic strategy of austerity, the authors of which are present beside me.

Sinn Féin filled a few accident and emergency units in its time.

The Fianna Fáil Party motion is carefully worded because that party agrees with austerity and cannot fully oppose health cuts based on austerity, not to mention the party's own appalling record in office from 1997 to 2011, not least in respect of health.

Less of the history lesson, please.

The Fianna Fáil Party had the opportunity to transform our health services, but squandered it just as it squandered so much else that could have made for a better society. It certainly had the time and means to make a difference. I appreciate that the current Government does not, but it none the less has a responsibility. Its members saw it and knew it when they stood in my current position. Despite the motion to which I am a party in the form of an amendment to the Fianna Fáil Party motion, I appeal to the Government. It is not down to the Minister, Deputy Reilly, alone. It is a collective shared responsibility. Changing the ministerial face would not be enough. A change in health policy is the absolute requirement.

I take it that my time has concluded.

Yes. I must ask the Deputy to conclude.

I will park some of what I had prepared to say. There must be a major change not only in health policy, but in the economic strategy being pursued if we are to avoid a meltdown in the public health services. The first step is not just the removal or resignation of the Minister in place, but equally the adoption of a health policy based on fairness, equity and access for all on the basis of need. Such a policy must be the cornerstone of our health services.

Deputies Maureen O'Sullivan and Finian McGrath are sharing five minutes.

I wish to discuss two matters in the couple of minutes available to me. At approximately 10.15 a.m. on Tuesday, 4 September, I returned to Leinster House and met the people with disabilities who were protesting outside. Two of them happened to be past pupils of mine. This morning, the Taoiseach stated that the cuts were dealt with swiftly, but how could a cut in respect of someone with a severe disability have been introduced? It should never have been on the agenda in the first place. They have many more stresses in their lives than we do.

We take so much for granted, such as getting out of bed in the morning, dressing ourselves, showering and going to the toilet. Every one of those actions must be thought through for a person with a disability, and the work of a personal assistant allows such people the dignity to carry on their lives as well as possible.

Three days later, people with mental health issues were outside the House protesting while the Minister of State, Deputy Kathleen Lynch, has been very vocal about the €35 million in funding and extra posts. The people involved are vulnerable and have enough stress in their lives without this additional worry. Leaving the moral and ethical argument out of this, on a purely economic scale, the Centre for Independent Living has indicated that to keep one person in hospital for a year amounts to €328,000, whereas providing a personal assistant would cost €119,000. The same calculations can be applied to older people and those relying on home care services and home help in trying to avoid bigger demands on nursing homes and hospitals. Cuts to home care packages will have a desperate effect; older people may be admitted to hospital for treatment but they may well end up staying there for longer if home care packages are cut.

I was outside the House today when people involved in home help were protesting. A number of these people were from East Wall and North Wall, so I know them personally. These people work far longer hours than what they are paid for, and we are in danger of losing that extra help. Cutting disability allowances, home help and personal assistant hours means that more people will become institutionalised or restricted in their homes. It will become more expensive to care for them.

The national substance misuse report had been awaited for a number of years, and it was a major collaborative effort between various Departments, agencies, community and voluntary sectors. It was published before the recess but it was disappointing that the Minister was not present at the launch, as that would have indicated that he took the matter seriously. I mean no disrespect to the Minister of State who was present. What has happened since as there has been no action taken on the report?

Alcoholism and addictions have a huge impact on society. It is ironic that one of the report's recommendations, if implemented, would generate income, and the other recommendations are cost-neutral. Nevertheless, the promised action, which could have had a positive effect, has not come about, whereas the action taken with regard to disabilities has had a profound negative effect.

I thank the Leas-Cheann Comhairle for the opportunity to speak to this motion of confidence in the Minister for Health. My criticism is based solely on politics and bad political decisions. It is important to say this is not about a person but rather a Minister and his Government, competence and accountability. Our people are hurting because of bad decisions and disastrous choices. We cannot have a Minister and a Government that when making a political choice look to hammer people with disabilities or senior citizens who need our care and support. It is not acceptable - it is criminal - to have people with disabilities camped outside Government Buildings wondering if their services will be removed. Fear, confusion and a lack of compassion have no place in any democratic or inclusive society. That is the bottom line with regard to the motion and the reason we have no confidence in the Minister.

The Minister and his Government were elected on promises of change and reform but in recent weeks we have seen fear, confusion and a lack of respect for people with disabilities, the elderly and the low-paid personal assistants and carers. We all knew there was a skeleton service before any cut was mentioned; this is not a case of waste in the health service but rather people needing help and support and getting a service as a right.

Over the summer we witnessed shameful events when the Minister did not speak to some of his Ministers of State and tried to pull off stunts. He was distracted and took his eye off the ball with regard to patient care and services for vulnerable people. Our citizens are, correctly, very frightened and angry. Yesterday I attended the Age Action Ireland conference in Croke Park, witnessing at first hand the anger, frustration and hurt felt by many of our senior citizens. They have had enough and the Government should listen to these people and address their concerns. Turning a blind eye is not the way forward.

There is also the case of thalidomide survivors, a group of whom in the summer indicated that the Government reneged on a commitment to them. There are 32 Irish people still alive from the 10,000 babies born worldwide with partial, malformed or no limbs. These people are in their 50s and 60s. In the programme for Government, Fine Gael and Labour promised to engage with them but to date, nothing constructive has happened.

This Minister and his Government should not be hitting the young, old, sick and disabled. They should instead hit the people with resources, take the money from them and run a proper health service.

Debate adjourned.
The Dáil adjourned at 9.05 p.m. until 10.30 a.m. on Wednesday, 19 September 2012.