Dáil Éireann díospóireacht -
Tuesday, 25 Sep 2012

Vol. 775 No. 3

Leaders' Questions

Deputy Micheál Martin

The Minister of State at the Department of Health, Deputy Róisín Shortall, teams from the HSE and the Department of Health and the Minister for Health, Deputy Reilly, agreed an objective set of criteria, internationally recognised, relating to urban and rural deprivation to be used in selecting primary care centres. They decided to select 20. However, behind the back of the Minister of State and parallel with all of this, the Minister seemed to have a different thought process entirely. After consulting Cabinet colleagues, he took a unilateral decision to add a further 15 to the 20, including two in his constituency. He published no criteria or provided no evidence base to justify this unilateral decision.

Public private partnerships have a significant commercial dimension. They involve general practitioners, allied health professionals, therapists and so forth. For this reason, above and beyond anything else, there must be objective criteria, fairness and transparency because various interests and consortia are entitled to bid and tender for such centres and projects. Is it appropriate that a Minister should ride roughshod over existing agreements and criteria and take decisions unilaterally which can benefit private sector interests? These are multi-million pound ventures with profit as a desired objective. There is nothing wrong with making a profit, but that is the key ingredient in this issue. It is equivalent to tendering, which is the reason Ministers should be at one remove from such decisions. Did the Minister know at the time of his decision who the preferred bidder for the Balbriggan site was? Was this disclosed?

The Minister for Transport, Tourism and Sport, Deputy Leo Varadkar, has described this as stroke politics. Others have described it as naked clientelism, but I am saying it is more than this. The commercial private sector dimension is significant, which is why the Minister is wrong in the decision he took. Does the Taoiseach agree that the Minister's actions were inappropriate and unacceptable?

The Taoiseach

Primary care development is a fundamental part of the strategy to reform the health sector. Clearly, primary care centres have enormous capacity to take people in, rather than having them go to accident and emergency units in the first place. Given the range of facilities that can, should and will be provided in primary care centres, they are important. There were broader criteria used than just the deprivation index in the selection of primary care centres. The criteria also included the impact on acute services in hospitals, competition and GP co-operation. The Minister and the Department of Public Expenditure and Reform accepted that competition was required to ensure there would be a cost-effective GP buy-in and on that basis the number of potential primary care centre locations was determined.

It is important to note that this is part of the overall stimulus package announced by the Minister for Public Expenditure and Reform some time ago, which included expenditure in the areas of road development, schools and primary care centres.

Each of these sectors was approved by the Government following consultations by the Ministers involved with their colleagues, and the same applied in this case.

It is also important to note that early this year the HSE set out its prioritisation for primary care centres. Deputy Martin will be aware that in some locations the HSE was already at advanced stages of discussion about the development of primary care centres, including the leasing of premises by GPs for primary care, and this was deemed the most appropriate way of delivering those centres. A number of other high-priority locations were selected for direct investment by the HSE using Exchequer funds from the HSE's capital allocation, and the remaining locations were then considered as being appropriate for public-private partnership development.

Deputy Martin will be aware that if one wishes to develop 20 primary care centres and one selects only 20 possibilities, one runs the risk of objections, non-buy-in by GPs, lack of competition and other factors. What the Government approved and signed off was a list of 35 primary care centres, with 20 to be developed. That does not mean that the first 20 will actually be developed, because of the factors that I mentioned. In order to get this moving as quickly as possible, taking into account situations in which there were leases involved, an intention to lease, direct Exchequer funding or PPPs, the Minister, in consultation with his colleagues, made a recommendation to the Government and the Government signed off on that element of the stimulus package for the development of 20 primary care centres from a list of 35.

Deputy Micheál Martin

We found all of this out through freedom of information requests and from the media. We found out nothing from the Government. In fact, the last parliamentary question that the Minister, Deputy Reilly, answered in May stated that urban and rural deprivation was the clear criterion. He said nothing about anything else, and we have received no documentation from the Taoiseach or the Minister about broader criteria. That was not an honest reply. The Taoiseach needs to be honest and transparent with the House in this regard.

What is clear from all of this is that the Minister of State, Deputy Shortall, plays by the rules, while the Minister, Deputy Reilly, does not. What is equally extraordinary is the degree to which the Labour Party hierarchy was willing to isolate Deputy Shortall to protect the Minister, and all in the name of deprivation. That is why Deputy Shortall stood her ground. Her letter to the Minister gives the lie to what the Taoiseach just said.

An Ceann Comhairle

Can I have Deputy Martin's question, please?

Deputy Micheál Martin

She wrote that when she met the Minister, Deputy Reilly, to discuss primary care policy on 29 February 2012, they agreed, and subsequently minuted, that "the provision of centres should be informed by needs analysis, with priority given to areas of urban and rural deprivation". Her letter goes on to mention the universal primary care team cementing that.

The Taoiseach has not been straight with the House on this issue. What has happened is unacceptable. It is extraordinary that the Taoiseach could not answer the question I asked him. Is it acceptable behaviour for the Minister to ride roughshod over established criteria which he had agreed with the Minister responsible for primary care, the HSE team and the Department of Health team?

An Ceann Comhairle

Thank you, Deputy Martin.

Deputy Micheál Martin

Will the Taoiseach at least agree that the Minister, Deputy Reilly, should come before this House make a statement on the issue, outlining why he did what he did, and allow Deputies from across the House to ask him basic questions on this matter? I understand a private notice question has not been accepted today. This is a national issue concerning the roll-out of primary care centres across the country.

An Ceann Comhairle

Deputy Martin is over time. Will he allow the Taoiseach to answer?

Deputy Micheál Martin

This is the only opportunity I have to raise this.

An Ceann Comhairle

I know, but the Deputy is over time.

Deputy Micheál Martin

It has been aired everywhere else except the Dáil. We have two or three minutes to raise it here and we have no further opportunity to do so. I ask the Taoiseach to agree that the Minister should come before the House today to make a statement and answer questions from Members of the House.

The Taoiseach

Of all the Ministers in this or any Government, Deputy Reilly has taken on the unenviable task of sorting out the wreckage left by his predecessors.

Deputy Timmy Dooley

Here we go.

The Taoiseach

The criteria used, for the information of Deputy Martin, were the deprivation index for the catchment population of the centre and the service priority identified by each integrated service area and local health office.

Deputy Micheál Martin

The criteria for assessment?

The Taoiseach

An accommodation assessment, which reviewed accommodation available from the primary care team within catchment areas, was carried out by the HSE.

Deputy Micheál Martin

We know that.

The Taoiseach

It looked at the quality of the accommodation and whether it was spread over more than one building. Additional criteria applied by the Minister, Deputy Reilly, were as follows: competition, GP co-operation, GP to population ratio-----

Deputy Micheál Martin

Could the Taoiseach produce the documentation on that?

The Taoiseach

-----and cost-effective GP buy-in.

Deputy Micheál Martin

Could the Taoiseach produce the documentation? This is all after the decision.

Deputy Pat Rabbitte

Deputy Martin never used to read the documentation he got.

The Taoiseach

Deputy Martin will be aware of primary care centres which have been built but are empty because doctors would not move into them.

Deputy Micheál Martin

That has nothing to do with it.

An Ceann Comhairle

Deputy, please.

The Taoiseach

Deputy Martin seems to have a propensity recently to keep talking.

Deputy Micheál Martin

I want answers from the Taoiseach.

The Taoiseach

If he wants to listen to the criteria, I will give them to him.

Deputy Micheál Martin

The Taoiseach is refusing to answer.

The Taoiseach

I will answer Deputy Martin and I will give him the criteria.

An Ceann Comhairle

Would Deputy Martin mind speaking through the Chair?

Deputy Micheál Martin

The Taoiseach is not giving me the criteria.

The Taoiseach

Maybe Deputy Martin does not want to hear.

Deputy Pat Rabbitte

Deputy Martin is trying too hard.

The Taoiseach

The remaining criteria were: existing health facilities; pressure on services, including acute services, to which I referred; funding options, including Exchequer funding through HSE build or lease; and, finally, the implementability of a PPP programme. This was accepted, and by deciding to create a list of 35, as I stated, rather than 20, the Minister, Deputy Reilly-----

Deputy Micheál Martin

Jumped. Maybe the Taoiseach wants to tell everybody else that the competition was 200.

The Taoiseach

-----provided positive encouragement for engagement and financial-----

Deputy Micheál Martin

The Minister leapfrogged centres.

An Ceann Comhairle

Sorry, Deputy Martin; would you please listen?

Deputy Micheál Martin

It is difficult, a Cheann Comhairle.

An Ceann Comhairle

Does Deputy Martin have difficulty staying quiet? I want to hear the reply.

The Taoiseach

-----and financial participation by GPs. As I stated to Deputy Martin, there is little point in having taxpayers' money put together for primary care centres that remain unoccupied because doctors could not agree among themselves. What the Minister, Deputy Reilly, put forward as his part of the stimulus package-----

Deputy Timmy Dooley

He would be well versed in looking after the doctors all right.

The Taoiseach

-----was a list of 35 based on these criteria-----

Deputy Micheál Martin

They leapfrogged others.

The Taoiseach

-----from which 20 would be provided.

Deputy Micheál Martin

They leapfrogged them. They jumped the queue.

The Taoiseach

In fact, Deputy Reilly consulted with all of his colleagues in that regard.

Deputy Timmy Dooley

If that were the case, they would all be in Dublin.

Deputy Micheál Martin

He did not consult with the Minister of State, Deputy Shortall.

An Ceann Comhairle

I thank the Taoiseach. We are over time.

The Taoiseach

As I also pointed out, the HSE is engaging with the National Development Finance Agency, as required, to progress the primary care centre element of the Government's public private partnership.

Deputy Micheál Martin

Will the Minister make a statement to the House?

The Taoiseach

The Minister is due to answer questions on Thursday in the House.

Deputy Micheál Martin

That is a joke. Come on.

The Taoiseach

Yes, I am coming on. The Minister will be here on Thursday to answer all-----

Deputy Micheál Martin

Will the Minister make a statement specifically on this issue?

The Taoiseach

-----and any questions from members of Deputy Martin's party or any other Member in respect of this matter-----

Deputy Micheál Martin

Dodging again.

The Taoiseach

-----as is his responsibility under his remit.

Deputy Micheál Martin

He should come before the House today.

The Taoiseach

The Minister will be here on Thursday to answer questions on this. Any other questions Deputy Martin can think of should be submitted before then.

An Ceann Comhairle

I call Deputy McDonald.

Deputy Micheál Martin

The Minister will be here for a two-minute priority question. I am talking about a private notice question. The Minister should come before the House.

An Ceann Comhairle

It does not qualify as a private notice question. Deputy Martin knows that as well as I do. I call Deputy McDonald.

Deputy Micheál Martin

I respectfully disagree. It does qualify.

An Ceann Comhairle

If Deputy Martin wants to take over the job of Ceann Comhairle as well-----

Deputy Micheál Martin

No, I certainly do not, but as the leader of an Opposition party, I know what is fit for a private notice question and what is not. The Ceann Comhairle has his opinion.

An Ceann Comhairle

It does not qualify, I am telling you.

Deputy Pat Rabbitte

Deputy Martin is under pressure.

Deputy Micheál Martin

I accept the Ceann Comhairle's opinion, but I think it is wrong.

Deputy Pat Rabbitte

Deputy Martin is under stress.

Deputy Micheál Martin

It is the wrong decision. I accept the Ceann Comhairle's right to do it, but I do not agree with it. It is a national issue.

The Taoiseach

They are down for Priority Questions.

An Ceann Comhairle

As a private notice question, I repeat, it did not qualify. I call Deputy McDonald.

Deputy Timmy Dooley

It was not accepted, as opposed to not qualified.

Deputy Mary Lou McDonald

The credibility of the Minister, Deputy Reilly, was dented and completely undermined long before his latest stroke. The involvement of the Minister for Health in private medicine and nursing homes at a time when those services in the public sector are being cut back and, in many instances, closed raises the most fundamental issue as to his suitability to hold the ministry. He clearly has a direct and evident conflict of interest.

Then there was the debacle around the €130 million of cuts to be visited on personal assistant hours, home care packages and home care hours, which led to the motion of no confidence in the Minister. Labour Party and Fine Gael backbenchers wrestled with their consciences and won, and they voted confidence in the Minister.

Deputy Michael McCarthy

Read on.

An Ceann Comhairle

Allow Deputy McDonald to pose her question.

Deputy Mary Lou McDonald

No sooner had they done that then the most recent farce played out-----

Deputy Brendan Griffin

Deputy McDonald did a lot over the years.

Deputy Mary Lou McDonald

-----that is, the addition of these primary health care centres which just happen to be in the Minister's constituency.

The Taoiseach stated that the issue of need was not the only criterion and said there were others. He mentioned competition and GP co-operation. Was the Minister of State, Deputy Shortall, aware of those additional criteria, and did she accept them, or is it the case, as she stated in her contribution in the Dáil, that there was - to use the euphemism - a lack of transparency in the decision-making around this?

This has been another stroke in the Government's stroke politics. The Minister for Transport, Tourism and Sport, Deputy Varadkar, at least got that right. How can the Taoiseach, the head of the reforming Government, stand over this? Surely, a Taoiseach who is so critical of Fianna Fáil and the Administration that went before this one, should ensure that he calls time where strokes are pulled by senior Ministers. The Taoiseach should tell us about the criteria. Did the Minister of State, Deputy Shortall, know about them? Does she know about them now? Is she now prepared to row back on her criticism of the lack of transparency on this issue?

The Taoiseach

I take as contemptible the Deputy's allegation of personal benefit by the Minister, Deputy James Reilly, in respect of his remit as Minister for Health. He has already given details on all of this to the House in a public statement. He is one of the few people with a genuinely passionate interest in shifting the structure and nature of how health is delivered in this country in the interest of the patient. This is not an easy task and the Minister is focused on getting the strategy right and implementing it.

The decision in respect of the primary care centres is to develop 20 primary care centres from a list of 35. I have provided Deputy Martin with the reasons it was necessary to have a list of more than 20, simply because a range of issues could arise, such as objections, non-buy-in, lack of competition, impact on acute services in hospitals and the range of services that must be provided through the primary care centres in order to be effective. As I have mentioned, some centres were in areas where a lease was arranged, some in areas where a lease was to be arranged, some had direct HSE-Exchequer funding and others were under the PPP programme. They are the sectors and the Minister has set out the criteria involved.

As mentioned, this particular development of primary care centres involves 20 from a list of 35. It remains to be seen which 20 get across the line, taking all the criteria into account. They were part of the Government stimulus package announced by the Government and the Minister for Public Expenditure and Reform and were signed off in individual sectors through discussions and recommendations by each Minister in consultation with his or her colleagues.

I am sure that at the end of all of this the Deputy will appreciate the importance and function of primary care centres to provide decent, first-class care and attention in many areas for people who need them. I wish to God we could provide more primary care centres in a shorter time because they are a part of the development of this stimulus package for primary care centres. Where they work well, they are very effective. I have been in a number of them and have seen at first hand the response from patients and the efficiency that applies when everybody buys into the provision of a really strong, effective primary care centre. This is so important for the future health of people all over the country.

Deputy Mary Lou McDonald

The Taoiseach does not have to convince me of the value of primary health care centres, which are the right model to pursue. However, that is not the issue at hand. Let me clarify that this is not personal to the Minister, but it is very clear that where a Minister for Health who presides over the public health care system and who has taken decisions to reduce bed numbers and close public nursing homes has an interest in private nursing homes, there is a clear and evident conflict of interest. It astounds me that this has not crossed the Taoiseach's mind. It astounds me that when making his ministerial appointments, the Taoiseach did not clarify the position with the Minister.

An Ceann Comhairle

Can we have the Deputy's question please?

Deputy Mary Lou McDonald

The Taoiseach did not answer my question in respect of the Minister of State, Deputy Shortall. She made the serious charge in respect of the selection of these primary health care centres. She said in this House that the decision making lacked transparency. Clearly, she had a very different understanding with regard to the criteria than the Taoiseach has articulated or than the Minister had. Will the Taoiseach give a straight answer? Did the Minister of State know about the additional criteria? If she did not know, has she subsequently been apprised of them? On foot of this, is she prepared to withdraw her charge of a lack of transparency?

It seems to me this has been stroke politics. However, perhaps the Minister of State has been furnished with the information and perhaps she takes a different view now. Can the Taoiseach tell us whether this is the case?

The Taoiseach

I am glad Deputy McDonald, on behalf of the Sinn Féin Party, accepts that what the Minister is doing is the right model. Second, it astounds me that the Deputy has the gall to stand up in this House, in view of the statements made by one of the Price sisters about the leader of the Sinn Féin Party.

Deputy Pádraig Mac Lochlainn

For God's sake, will the Taoiseach ever once answer the question without -----

(Interruptions).

An Ceann Comhairle

The Taoiseach, without interruption, and please stick to the question.

The Taoiseach

The Sinn Féin Deputy made an articulate point about clarity and transparency, but she should also include truth. The truth of the matter is that the Minister for Health, as one of a number of Ministers with regard to the stimulus package -----

Deputy Micheál Martin

That is not the truth.

The Taoiseach

Deputy Martin already put his question.

An Ceann Comhairle

Speak through the Chair, please.

The Taoiseach

The Minister for Health, as one of a number of Ministers in regard to the stimulus package announced by the Government, put forward the recommendations after consultation with his colleagues in regard to the development of 20 primary care centres from a list of 35, covering a range of criteria I have set out here. The Minister was in touch with all his colleagues.

Deputy Mary Lou McDonald

Did that include Deputy Shortall?

The Taoiseach

Obviously, the decision of Government is based on moving forward with the development of the primary care centres as quickly and as effectively as possible, covering the sectors mentioned and the criteria laid down in regard to each.

I am very glad the Deputy accepts this is the way to go with primary care development and we look forward to this element of the stimulus package moving to commencement and completion as quickly as possible.

Deputy Richard Boyd Barrett

I also want to ask about the Government's priorities and its notion of reform when it comes to the health service and about a particular area of our health service. In the Visitors Gallery today are approximately from 50 to 60 home help assistants who provide vital services of care, support and backup to elderly and disabled citizens across the country, some of the most vulnerable sectors of society. These home help assistants have come together over recent weeks because the Government, as part of this raft of cuts, has cut 600,000 hours of home help. This comes on top of 500,000 hours of cuts that happened earlier in the year. More than 1 million hours of home help services have been cut as part of the so-called reform.

The Government is also moving to privatise home help services. Most of the home help assistants here today work for voluntary not-for-profit organisations. The Government has moved to outsource these services to multinational companies like Comfort Keepers, owned by Sodexo, a French multinational.

An Ceann Comhairle

Would the Deputy mind putting his question?

Deputy Richard Boyd Barrett

That multinational, for example, had to pay fines in compensation to New York City for overcharging the city for food and facilities management services. This is the sort of company it is. The Government is outsourcing home help services to that company, degrading services here and cutting services to the most vulnerable sectors of society and attacking the pay and conditions of home help assistants who provide those services. I ask the Taoiseach to reverse the cuts in home help services that are affecting the most vulnerable sectors of our society, to end the privatisation of home help services, to guarantee proper contracts and security of earnings and end the attacks on the conditions of more than 13,000 home help workers in this country who look after our most vulnerable citizens.

An Ceann Comhairle

The Deputy is over time and should please allow the Taoiseach to respond.

Deputy Richard Boyd Barrett

Instead of attacking them, why does the Government not go after the consultants who are doing private work in public hospitals or why does it not go after the multinational companies that are overcharging the HSE for drugs?

The Taoiseach

I assure Deputy Boyd Barrett that the recent consultations at the Labour Relations Commission with regard to consultants' contracts will bring enormous benefits in respect of 24/7 cover, rostering, savings and greater productivity. There are a number of matters that will relate to the Labour Court in due course. I further assure the Deputy that the Minister and his departmental officials are intensely involved with the pharmaceutical companies on issues like the cost of drugs and the delivery of medicines to this country's health care sector. I can confirm that a great deal of discussion and intensive negotiation has taken place in that regard in the recent past.

I respect the work that home helps do throughout the country. I have met many of them. I know the work they do when they call to those who need care and attention. I know the work they do in the morning, the afternoon and the evening. It is important for Deputy Boyd Barrett to appreciate that home helps are concerned to ensure that those who require care get the best care that can be given to them. That is the Minister's intention. Obviously, the circumstances of those who receive home help care can change - circumstances may change within the family or the person might die - and these things are reviewed as a result. At the same time, another person in different circumstances might be making a home care application. The Minister, Deputy Reilly, and the Government are determined to ensure that where home help is needed, home help will be given.

Deputy Michael McGrath

It is not happening.

The Taoiseach

It is only right and proper that home help is provided on the basis of the need of the person, which is of paramount importance.

Deputy Timmy Dooley

It depends on the criteria used when assessing the person's need.

The Taoiseach

Home help will continue to be delivered with sensitivity and effectiveness.

Deputy Richard Boyd Barrett

How can the Taoiseach square the Government's commitment to provide home care services to people with its decision to cut more than 1 million hours of home help in a single year?

Deputy John Halligan

Exactly.

Deputy Richard Boyd Barrett

How can he square the respect he has expressed for home helps with the outsourcing of home care services to a multinational company that wants to pay home helps by the minute? Does he think somebody who is paid by the minute - who has to clock in according to the minute and has to leave after exactly 15 or 30 minutes - will give the sort of service that is required to the elderly or disabled citizen he or she is supposed to be looking after? The priority of private multinational companies in this sector is to make money out of the disabled and the elderly, rather than to provide them with services or to treat the workers who provide those services with the respect they need. I ask the Taoiseach to reverse the cuts in home help hours. He can get savings from the consultants who are doing private work in public hospitals and are paid obscenely high public salaries. Further moneys can be saved by cutting the prices that are paid to multinational companies. That should be done instead of attacking the elderly, the disabled, the most vulnerable people in our society and the workers who provide these services, who are already inadequately paid for the vital work they do.

The Taoiseach

The Deputy underestimates the scale of the impact of the conclusion of the Labour Relations Commission negotiations on consultants' contracts and rostering. As a result of the conclusion of those talks, services will be delivered much more effectively and substantial savings will be made. When negotiations on the cost and delivery of drugs in the Irish health system come to a conclusion fairly soon, I hope the Deputy will find it within himself to appreciate the progress that will have been made. The important point about home care and home help is its effectiveness. I respect the work done by the home care personnel I meet all over the country. Many of them have never been bound by the sort of clock alluded to by the Deputy. Many of them have always gone out of their way to help those to whom they give care and attention. It is in their nature to do that. For example, a home help might return to a person's house more than once during the course of the day, even if that house is some distance away, because they know the person involved.

Deputy Richard Boyd Barrett

That is the point. All of that is going to change.

The Taoiseach

Contrary to what the Deputy has suggested, it is not a case of fitting this into a segmented or clocked system that will be timed by the minute.

Deputy John Halligan

It is happening all over the country.

The Taoiseach

It can depend on the mood and the circumstances of the person who is receiving home help.

Deputy John Halligan

People are being given breakfast and dinner at the same time in the morning. It is a disgrace.

The Taoiseach

Issues can arise within the family in all sorts of circumstances.

Deputy John Halligan

It is disgusting.

The Taoiseach

These serious and sensitive matters, which are being dealt with in cities, provincial towns and rural areas, are not issues to be barked about in this Chamber.

Deputy Richard Boyd Barrett

The Taoiseach is welcome to meet the home helps in the Earl of Kildare Hotel, where they are meeting this evening. Members of the press have been invited as well.

The Taoiseach

I repeat that the good people in the Gallery, like many thousands of others across the country, do the best they can to ensure the best help is given to those who need assistance in their homes. As far as the Government is concerned, those who continue to need home help care will get it in as effective and sensitive a way as possible.

Deputy John Halligan

They are not getting it.

Deputy Joan Collins

How can they get it in half an hour?

The Taoiseach

I made this point when I spoke about the substantial savings that will arise from the consultants' agreements over the period ahead.