Leaders' Questions

Since we last spoke in the House, the Minister of State at the Department of Health, Deputy Shortall, has resigned. She gave a very revealing interview on Marian Finucane's radio show at the weekend in which she confirmed everything we have been saying in this House over recent months about work on primary care being blocked and poor management of the health budget, so much so that we are now facing the most appalling cuts because of the Minister's failure to tackle these issues.

The Taoiseach might recall that I asked three weeks ago whether the delegation of ministerial orders had been laid before the House on the former Minister of State's functions. The Taoiseach did not seem to know if they were or not and said he would get back to me. I checked and they were laid before the House in September 2011. What is most revealing is that while they cover medicinal products and the poisons Bill, among other things they excluded completely any reference to primary care. Despite appointing the Minister of State, Deputy Shortall, saying she would have special responsibility for primary care, there is not a mention of primary care. Was it not then that the Taoiseach, the Tánaiste and their Cabinet colleagues ditched and isolated the Minister of State? She was not given statutory delegation for primary care and despite knowing from freedom of information requests that she had sought it on a number of occasions, it fell on deaf ears. Who excluded primary care from her delegated statutory authority as Minister of State?

The Minister of State met the Tánaiste and the Taoiseach during the summer to resolve this issue, and the suggestion was that a summer holiday might sort it out. We know the Minister of State had deep reservations about the Minister's performance that went beyond the added primary care centres. They went to the core of the implementation of the programme for Government itself.

As for the added primary care centres, the Minister, Deputy Reilly, has changed his story repeatedly. He misled the Dáil last week by claiming that Balbriggan and Swords lost out and were swept from high priority to low priority. There was no prioritisation system in 2007, as the former Minister of State, Deputy Shortall, has confirmed and as have others close to the issue.

Originally, the Minister, Deputy Reilly, stated that he consulted ministerial colleagues and officials, but no ministerial colleague can be found to confirm that he or she was consulted. Several Ministers, namely, Deputies Varadkar, Burton, Quinn and Creighton, have stated they are not familiar with the details.

I thank the Deputy.

Can the Taoiseach spell out the criteria? Can he confirm that he actually approved of the addition by the Minister, Deputy Reilly, of those 15 centres and of the basis on which he did it? Moreover, I presume the Taoiseach will facilitate the Minister's appearance before the House today to make a statement and to answer questions in this regard given that he is doing so with the Fine Gael Party. Moreover, I note the new Minister of State, Deputy White, also has been asked to find out the details relating to the criteria.

When Deputy Martin asked me the question last week about the statutory instrument, I could not recall exactly the nature of the instrument or when it was laid before the Dáil and I promised to revert to him. He is aware that all statutory instruments refer to a legal base. There is no legal base to a primary care Act, so in terms of statutory instruments they refer specifically to narrower confines. However, primary care, no more than public transport or any other issue, covers a range of activities.

I can confirm to Deputy Martin that the position is that issues which were raised in recent days about the pharmaceutical industry and the cost of drugs, insurance claims and the issue concerning consultants being re-rostered and the substantial savings that will accrue over the coming years have all been the focus of pretty intense negotiations with conclusion in areas of these in the past period and with more to come. In respect of the primary care centres, when I addressed this matter last week, I told Deputy Martin they were in different sectors, in that leases were involved in some, direct Exchequer funding was involved in others and, in some cases, the primary care centres would be provided under a public private partnership, PPP, system. This is all part of the stimulus package of more than €2.5 billion brought forward by the Government which covers the areas of transport, health, justice and education, as well as the major development at Grangegorman. The entire seamless package was announced by the Minister for Public Expenditure and Reform and, obviously, was approved by the Government.

From his own experience, the Deputy is aware of the value of primary care centres and how fundamental they are to providing a proper health system and health structures nationwide. I have visited a number of such centres myself, including one in Deputy Calleary's native town, which is very efficient and competent.

It had nothing to do with the Taoiseach.

Those responsible provide a wonderful opportunity and level of service for people.

Were there strokes involved?

It has had the highly beneficial consequence of not having numbers turning up to accident and emergency centres who do not need to go there. More primary centres are needed and what has been announced by the Minister for Public Expenditure and Reform is but part of the requirements that are needed in this regard. There will be more to follow because more are required.

The Taoiseach did not answer any of the questions I asked. I do not buy his answer in respect of the statutory order. However, I asked him specifically whether he approved of the adding of the 15 centres. This pertains to public private partnerships, which, as I noted last week, have a strong commercial dimension to them because they involve the State entering into a contract with individuals, a company or an entity. Therefore, there must be a transparent and open process. It is almost equivalent to a tender situation. It is a commercial contract. Consequently, one cannot simply fudge it and this has been a major problem since this issue first arose. Moreover, the story keeps changing all the time. The Taoiseach might indicate what 15 sites were displaced by the 15 that were added, given the list that Deputy Shortall had put together. The more I consider this saga from the outset-----

The Minister, Deputy Rabbitte, is happy at any rate.

-----the more I am reminded of a poem by Francis Duggan, "One Lie Leads To Another Lie So Happens To Be True", which goes:

When you tell one lie it leads to another

So you tell two lies to cover each other

Then you tell three lies and, oh brother

You're in trouble up to your ears.

Thank you Deputy.

I would never apply that to the Cabinet and so on-----


A Deputy

Did the Deputy do that for his junior certificate?

-----but that seems to be the position in respect of this saga.

That is in the Koran.

The Deputy must have written that when he was in government.

The Fianna Fáil handbook.

Can the Taoiseach confirm the Minister, Deputy Reilly, will come into the House to make a statement? Is that the position? There has been a request by the Opposition but I am unsure whether it has been acceded to. Unquestionably, however, given all the different versions Members have heard on this matter, given that Fine Gael is having a meeting to discuss it and given that the Minister of State, Deputy White, has been sent in by some of his Labour Party colleagues to find out the reason they were added, the least one can expect is for Dáil Éireann-----

Thank you, Deputy. We are over time.

-----to have an opportunity to get a clear, honest and truthful account of how the 15 sites were added.

While I am unsure from what shelf in his archives the Deputy withdrew the poet's lines-----

I believe it was from inside the Taoiseach's manifesto.

I am trying to make it easy for the Taoiseach.

-----perhaps before producing it here in the Chamber, he might have reflected on the fact that people on his side of the House stated "I didn't know the IMF was here; it is not here".

Like the Taoiseach did not know about the primary care centres.

Why did the Taoiseach vote for it?

Deputy Martin himself stated this was the cheapest bailout in history.

The Taoiseach should deal with the here and now.

Moreover, he appeared on many television screens around the world on his travels stating that there was no need for a bailout and that it would be preposterous for Ireland. He should not come into this House and lecture Members with a poet's words. The fact of the matter is that to put together a proposal for primary care centres, be they where leases were involved, where direct Exchequer funding was involved or the PPP system-----

This is waffle.

No, I referred to public private partnerships.

What were the criteria?

-----one actually needs more than the number one sets out to put in place because one would not wish to be subservient to vested interests.

A Deputy

Stroke politics.

But there already was a list.

One would not wish to be caught in a situation where, for instance, general practitioners would not buy into using the facility.

The Minister, Deputy Reilly, would know all about that.

Yes, but there already was a list beyond the 20 sites.

Consequently, the proposal is to have 20 primary care centres under the PPP system. However, if one states they are the only 20 the Government intends to put in place, anyone could refuse to buy into that and therefore, one does not get the results one seeks.

No, one follows the rankings.

One follows the rankings as per the system.

The Minister has outlined to the House the reasons for expanding the criteria beyond deprivation only.

No one believes him.

They are also to provide for competition, to provide for dealing with potential vested interests-----

They were his criteria and his alone. There was a very interesting parliamentary question and reply last week. The civil servants are not going with it.

-----to deal with problems that arise with objections in certain locations and so on. I think Deputy Martin can agree that primary care centres are a fundamental part of the changing of the structure of the delivery of health services.

I have seen them myself and they are operating exceptionally well. I hope the process that is under way to bring to a conclusion the provision of these 20 primary care centres, for which a great deal of development is needed before they become a reality, will result in the provision of those centres of excellence and in confidence for people in those locations.

Is the Minister coming before the House?

They will become a reality out of the 35 sites.

He is not coming before the House.

Under the Government's regime, public nursing homes are under threat, as are services for the elderly. Last week, the HSE put in place a public consultation process to consider options for the future of the Cottage Hospital, Drogheda. At the same time, a statement from two Government party Deputies, Deputy Nash and the Minister of State, Deputy O'Dowd, claimed they had agreed a conclusion to this process with the Minister for Health, Deputy Reilly. By so doing, they totally undermined the process, the rights of concerned citizens, the elderly themselves, their families and local representatives. In the programme for Government, the Taoiseach promised an end to the old politics. He promised to honour the trust of the electorate and to break from the corruption of Fianna Fáil. Tá sé go han-soiléir, áfach, go bhfuil an Rialtas mar Fhianna Fáil. Tá sé ag déanamh na rudaí céanna agus níl an córas sláinte ag obair ar son saoránaigh. Tá sé go han-mímhorálta go bhfuil 17,000 duine ar an liosta feithimh ach, ag an am gcéanna, go bhfuil Teachtaí an Rialtais ag deanamh strokes arís.

Tá siad ag strócáil.

In the management of the health services in the primary care centre debacle and in this little deal concocted by two Government party Deputies in respect of the cottage hospital, one finds the same old stroke politics. The Taoiseach should tell Members whether he believes it is appropriate that two Ministers and a Government party Deputy should undermine a process of public consultation in this way.

Tá fáilte roimh an Teachta Adams thar n-ais mar ní raibh sé anseo an tseachtain seo chaite. In any event, as for the development of the plans for residential services for older people in County Louth, the HSE Louth-Meath primary services unit established a group to identify those options and to address existing pressures on the existing Cottage Hospital, of which Deputy Adams is aware.

That review is now complete. The detailed options appraisal report has been prepared. The HSE Dublin north-east region will publish this report next week and there will be the commencement of a full public consultation process. It has already commenced informal meetings, as the Deputy will be aware, with residents of the Cottage Hospital and their families to discuss concerns they may have at this time. A similar options appraisal report for St. Joseph's Hospital in Ardee will be published in the coming weeks and will be the subject of further discussions. In that regard, the HSE is also involved in discussions about the future of public nursing homes and a conclusion to that will be published by the Minister for Health in due course. Clearly the HSE is also carrying out a viability analysis on the future of all long-stay nursing homes in order to maximise the numbers who should be retained within-----

The private sector.

-----the existing staffing resources. That review will focus on a number of areas, including any home's ability to meet the changed HIQA standards for staffing and availability, clearly in some cases taking into account the structure, the age and the environment of a number of these homes throughout the country.

The Taoiseach has totally missed the point I was making. He said the HSE would publish its conclusions. The Minister of State, Deputy O'Dowd, who is sitting behind the Taoiseach, and the Labour Party Deputy for the area have said, with the support of the Minister, that the conclusions have already been published. They have already said what will happen at the end of this process. I attended the consultation process. What is the point in the HSE having such a process? The point I was making is that this is another case of stroke politics. This is parish pump politics and the people who are suffering are those who are elderly and in need of care.

That is rubbish.

The Minister engaged in this kind of politics in his constituency with the primary care centre debacle. He has also failed to tackle consultants' pay and the price of drugs. He has failed to recoup money from private health insurance companies. He has failed to introduce free GP care - I could go on. However, he has imposed prescription charges on medical card holders, slashed funding from home help services and is closing public nursing home beds, including in County Louth. I will ask the question again. Does the Taoiseach believe it appropriate that two Ministers and a Government Deputy should behave in this way, undermining a process of public consultation?

The Minister of State, Deputy O'Dowd, advises me that funding is in place for the Cottage Hospital to become a step-down facility with more than 30 beds-----

The process is not finished.

-----arising from the options that were published on this matter last week. What is required and what will happen not just in the north east but throughout the entire country is a public consultation about where-----

There is no point doing it.

-----we want to be with the health system in the years ahead. Clearly we need an effective and efficient system that delivers the best health care for all patients based on their medical requirement as distinct from what they have in their pockets.

That is not what is happening.

The Taoiseach should tell that to the Minister for Health, Deputy Reilly.

As the Deputy well knows, we cannot have centres of excellence at every crossroads.

There are 40 people on trolleys in Drogheda and that is not a crossroads.

There will be changes, which people understand, but it must be as a result of consultation between everybody involved so that when a person becomes sick or has an ailment or a requirement in any part of the country-----

They get a trolley.

-----in the initial case they either have access to a primary care centre or, if it is a requirement for a hospital, they are able to travel there efficiently and effectively in order to get the treatment they need. In respect of the older people, the standards that apply need to apply across the country. The Deputy does not want elderly people in his constituency to be subject to inferior accommodation or facilities. There has been a very big juggernaut-----

It is called James Reilly.

-----for the past 30 years, which needs to be changed and will be changed. While the change is always difficult-----

Nothing happens.

-----it is in the best interests of the country and the people. The main focus needs to be the patient, whether it be a child, young person, middle-aged person or elderly person. That is where the focus of the change and changing structure needs to be and that is where it will be.

With two months until the budget, the kite flying from Ministers is already under way. We have already heard about the slashing of child benefit and I dare say this is only the tip of the iceberg over the next eight weeks of rumours and so-called leaks. I would like to remind the Taoiseach of one thing before the Government begins its next round of imposing penalisation on the people. Last year's budget has proved to be one of the most regressive in the history of the State, disproportionately affecting those already struggling. As the Nobel Laureate, Joseph Stiglitz, has said, austerity never works to resolve economic downturns. He said that austerity instead turns downturns into recessions and plunges recessions into depressions. A succession of budgets dragging down domestic demand and delaying recovery is not the answer. There are other options if only the Government would consider them.

Increasing the effective tax rate for high earners by just 1.5 percentage points would generate an extra €650 million in additional revenue. A wealth tax could also generate more than €200 million. The Government would effectively get €850 million just by a moderate targeting of high earners. Those are just two proposals the Nevin Economic Research Institute has published in its strategy for an alternative adjustment which would lead to the same deficit outcome of 7.5% of GDP but also provide for the protection of front line services and social protection.

The Government's plans will result in the loss of 29,000 jobs next year, whereas this costed proposal would save 21,000 of those. While there is no way to fast-track economic recovery, the path the Government is taking is the wrong one. There is an alternative to penalising people while still generating the revenue required. Does the Government intend to continue to burden those who cannot take any more or will it ensure that those can pay do?

I ask the Deputy to give my regards to his fellow county-people following their victory in the all-Ireland football championship.

Get that over with first.

Let me be clear about a few things. The Commission on Taxation and Social Welfare produced a report on child benefit. I have not seen this report nor has it come to Government. Matters of a budgetary nature are a matter for consideration by the Cabinet collectively and that is what the Cabinet will do in regard to the very challenging preparation work the Minister for Finance, Deputy Noonan, has to do for 2013. The Deputy seems to forget the country is in a bailout programme and we do not have money to throw around as happened in years gone by.

The Deputy's quotation from Professor Stiglitz is incorrect. He said that austerity rarely works. I happened to be there to welcome 5,500 members of the International Bar Association to our country. They will be here for a week or longer, which will have a dramatic impact on the economic spend locally and give people from throughout the world a flavour of the personality of Irish people.

As we prepare for the Presidency of the European Union on 1 January, our focus is on growth and jobs because that is where the future of the country, and countries of the eurozone and European Union, lies. We have already made it clear that in our preparations for this Presidency that is where the focus will be - on the development of the Single Market and the continual opening of opportunities for jobs and business. I invite the Deputy and others to come to the House the week after next in order to participate in the economic debate that has been requested a number of times, taking into account the Irish Fiscal Advisory Council report, the IMF report and others.

The Deputy can feel free to criticise Government, as I am sure he will, or to put forward constructive suggestions for consideration by the Minister for Finance as he prepares to bring his recommendations to Government. I invite him, rather than simply say we can achieve savings of €200 million here or there, to justify his proposals the next time. We have moved on from people assuming that we can transform our economy overnight. We are in a very challenging position, as the people know. I expect the Deputy to back up proposals put forward in his contributions.

I would like to pass on my condolences to the people of Mayo on their loss last Sunday.

I accept them.

Perhaps the Mayo team will win next year if they do not meet the Donegal team again.

The proposals I put forward are serious ones which have been costed. I believe they will stand up to scrutiny. We must achieve a balance between cuts and revenue. The Government's agenda is one of cuts to the income of people who cannot afford them, many of whom are going to the wall. One of the proposals which I put forward today would generate extra revenue through the targeting of people who can afford to pay extra. As per that proposal, people earning €100,000 would pay an extra €1,500 in tax. Surely these people can afford to carry that burden. We should not be targeting cuts to child benefit at people on low incomes and those in receipt of social welfare benefits who cannot afford that hit, or be forcing them into having to go cap in hand to secure an increase. We should be targeting the people who can afford to pay. The Taoiseach should consider and take on board my proposals, thus targeting the people who can afford to pay and protecting those who need our help.

I again invite the Deputy to put his proposals on the record of the House the week after next. Any constructive suggestions which the Deputy has to make will be listened to. I also invite him, as someone who can well afford to do so, to pay his household charge, which will go in part towards the provision of services for the elderly-----

Hear, hear. The Deputy should not be lecturing other people about what to do.

-----people in Killybegs and the constituency which he serves. The Deputy, as a legislator, should obey the law of the land rather than take a deliberate opposite view for opportunistic purposes. The Deputy is well able to pay the €100 household charge. I invite him to do so.

Get it from the tax exile billionaires first.

The voice of Siberia.