Dáil Éireann díospóireacht -
Wednesday, 8 May 2013

Vol. 802 No. 2

Leaders' Questions

Deputy Micheál Martin

Some very clear promises and commitments were given in the programme for Government. They followed the promises that were made during the general election campaign. The programme for Government states:

Universal Primary Care will be introduced in phases so that additional doctors, nurses and other primary care professionals can be recruited .... Access to primary care without fees will be extended in the first year to claimants of free drugs under the Long-Term Illness scheme at a cost of €17 million. Access to primary care without fees will be extended in the second year to claimants of free drugs under the High-Tech Drugs scheme at a cost of €15 million. Access to subsidised care will be extended to all in the next phase. Access to care without fees will be extended to all in the final phase.

These promises and commitments were clearly given. Phase 1, which was to cover people on the long-term illness scheme, has not been delivered. Two deadlines were missed before it was abandoned altogether.

I am reminded of last year's debacle regarding the primary care centres. The then Minister of State, Deputy Shortall, said some fairly hard things about the commitment of the Minister, Deputy Reilly, to primary care. She has been proven correct. Even though she was forced out of office, she knew what she was doing in terms of delivering primary care. She did not get any support from the Minister, the Taoiseach or her colleagues at the Cabinet table at the time. She was forced out of office for calling it right on that occasion. Her suggestion that the senior Minister had taken the money and used it for other purposes across the health services was quickly rejected by the Minister, Deputy Reilly. His response on 8 October 2012 was to say "No, the money is there and it [the scheme] will be brought in before the end of this year, absolutely".

Deputy Willie O'Dea

Absolutely.

Deputy Micheál Martin

It is clear that he was not telling the truth.

Deputy Barry Cowen

He must have been on a lorry.

Deputy Micheál Martin

No legislation has been published. No talks with the IMO about the contracts have been initiated. There has been no delivery of the promises.

Deputy Finian McGrath

Calamity James.

Deputy Micheál Martin

Why did the Government make promises again and again and again on this issue?

Deputy Willie O'Dea

To get votes.

Deputy Micheál Martin

It made those promises only to break them again and again. The Labour Party is still facilitating this-----

Deputy Michael Healy-Rae

Where are they?

Deputy Micheál Martin

-----by providing cover to the Minister, Deputy Reilly, and the Government.

Now, the Minister of State, Deputy White, we have been told, is wandering the offices of Government Buildings with instructions to go and do research on other strategies.

An Ceann Comhairle

The Deputy's time is up.

Deputy Micheál Martin

With the health insurance system falling into disarray, waiting lists going up and this debacle with free GP care, what actually has to happen for the Taoiseach to realise what his Cabinet colleagues privately acknowledge and what the rest of the country has known and understood for quite some time, namely, that the Minister, Deputy James Reilly, is not the man to lead one of the most important Departments in this country?

Deputy Finian McGrath

Calamity James.

Deputy Michael Healy-Rae

Broken promises.

The Taoiseach

Deputy Martin reminds me of what he said himself many years ago, which is that it takes longer to get things off the ground in health than in any other Department. He is quite right.

Deputy Billy Kelleher

The Minister, Deputy Reilly, is firmly on the ground.

Deputy Dara Calleary

He is digging a hole for himself.

The Taoiseach

I saw the story this morning about free GP care for those with long-term illness. The Minister of State, Deputy White, is dealing with this matter very effectively.

Deputy Timmy Dooley

He is ignoring the promises.

Deputy Dara Calleary

It is all the Labour Party's fault.

The Taoiseach

Actually, what the Minister of State has done here is to look at the situation and, if one likes, take a stocktaking view of what has happened and needs to happen. It is important to say to Deputy Martin that the Government is fully committed to delivering free GP care in its first term of office, as set out in the programme for Government. No decision has been taken to go back on that. It is important to remember that, ultimately, the entire population will be covered by a free GP service.

When the Minister of State, Deputy White, came before the Cabinet sub-committee dealing with health recently, he pointed out that it will be necessary to introduce complex legislation to provide free GP care to those with long-term illness.

Deputy Dara Calleary

It has been two and a half years.

Deputy Barry Cowen

The Government has the same legal adviser now as it had two and a half years ago.

An Ceann Comhairle

Would the Deputies mind?

The Taoiseach

The Minister of State made a very valid point. He pointed out that the legislation that would be required to deal with free GP care for persons with long-term illness would obviously have to have a legal basis for eligibility-----

Deputy Barry Cowen

Most legislation does.

The Taoiseach

-----and that eligibility was based principally upon means, that is, income and residency. The legal framework for eligibility under the first phase of free GP care would be based on a medical condition-----

Deputy Timmy Dooley

That is the logarithmical progression.

The Taoiseach

-----and that first phase would require a new legal and administrative arrangement setting up doctors panels for assessment of eligibility of the persons with long-term illness in the first place.

A Deputy

All very complex.

The Taoiseach

What the Minister of State, Deputy White, pointed out was-----

Deputy Dara Calleary

Where is the Minister, Deputy Reilly, in all of this?

The Taoiseach

-----that he would be far more effective in looking at the longer strategy in implementing the roll-out of free GP care beyond just that sector dealing with long-term illness, because one would have to set up a bureaucracy to deal with the assessment and requirement for determining eligibility for GP care for persons with long-term illness.

Deputy Timmy Dooley

He is fairly good at getting rid of those.

The Taoiseach

He said he wanted six weeks to look at the entire scheme and that he would report back by the end of May. What he has validly pointed out is that it is not effective to put in place a legal, administrative, bureaucratic assessment-----

A Deputy

Why did he make the promise?

The Taoiseach

----- for free GP care for a sector with long-term illness and then have to move on to the other sectors. He said he wanted to look at the entire scheme, and I support him in that.

Deputy Dara Calleary

What about the Minister, Deputy Reilly?

The Taoiseach

He will report back to the Cabinet sub-committee by the end of this month with a view on the longer-term, more effective and less administratively costly roll-out of free GP care, which is ultimately to cover the entire population.

Deputy Dara Calleary

What about the Minister?

The Taoiseach

The story I read today in the national newspaper is, in the main, accurate but it does not say what the Government has not done here - the Government has not made a decision to end free GP care. What the Government has done is authorise the Minister of State, Deputy White, at his request, to look at the longer view-----

Deputy Timmy Dooley

He is getting thrown to the wolves.

Deputy Emmet Stagg

Deputy Dooley is talking through his hat.

The Taoiseach

-----and a more effective appraisal of the entire scheme, rather than focus on legislation dealing with one sector which would require a legal base, an administrative set-up, a bureaucratic system and panels of doctors for assessment of eligibility on medical grounds for those who would be covered. I support him in this.

I support him in this.

Deputy Timmy Dooley

He is finished, so. It is all over.

An Ceann Comhairle

Would you ever stay quiet, please?

The Taoiseach

It is a valid stocktaking exercise by a Minister who is taking into account the longer scheme.

An Ceann Comhairle

I do not know why Members ask a question and then do not listen to the answer.

Deputy Willie O'Dea

If we got an answer, we would be all ears.

An Ceann Comhairle

Some Deputies in the Chamber would like to hear the answer, not the mumbling that goes on in the background.

Deputy Willie O'Dea

The mumbling is all from the other side.

An Ceann Comhairle

Would you, please, allow Deputy Martin to ask a supplementary question and we will then have an uninterrupted reply from the Taoiseach?

Deputy Micheál Martin

I have some sympathy with my colleagues on this occasion, a Cheann Comhairle, and I agree 100% with you.

An Ceann Comhairle

I do not agree with them and I happen to be in the Chair.

Deputy Micheál Martin

I know you do not. The response is very much that sort of "logistical, logarithmic progression" or regression mentioned when the Minister, Deputy Reilly, was before the House to deal with primary care centres. That is an extraordinary reply from the Taoiseach. I commend him on managing to give a reply to a question on the Minister, Deputy Reilly's suitability to lead the Department of Health without once mentioning the Minister, Deputy Reilly, in his reply. He mentioned the Minister of State, Deputy White, about 15 times.

The Minister of State, Deputy White, is now saying it is very complex and that he has to consider the legislation governing eligibility and so on. Again, I must remind the Taoiseach what the Minister, Deputy Reilly, said last October in response to the former Minister of State, Deputy Shortall. She called this last year for the Taoiseach and the rest of the Cabinet when she said there was no commitment to the primary care commitments in the programme for Government. She was forced out of office and she got no support. In response to that, the Minister, Deputy Reilly, said in October "No, the money is there and it will be brought in before the end of this year, absolutely". There was nothing about complexity or eligibility difficulties.

An Ceann Comhairle

Could we have your supplementary question, please?

Deputy Micheál Martin

He made that promise about five or six times in the last two years. He has been questioned repeatedly by journalists and by Opposition spokespeople, including Deputy Kelleher, Deputy Ó Caoláin and others, in regard to the progression of this particular commitment and the promise that was made. Up to very recently, he was denying all comments or statements to the effect that this would not be delivered and would not go ahead. Now, the Taoiseach is saying the Minister of State, Deputy White, has taken charge of the whole debacle and that he is dealing with it effectively. Dealing with it effectively, in the words of the Taoiseach, means, two and a half years on, that 56,000 people who were on the long-term illness scheme and who thought they were going to have free GP care in the first year of this Government are now being told that, for them, it has been abandoned - that particular commitment has been abandoned and will not proceed. That is how the Taoiseach describes and defines dealing effectively with a promise solemnly made by him and the Minister, Deputy Reilly. I repeat the question I asked the Taoiseach and which he avoided. What has to happen for the Taoiseach to realise what his colleagues privately acknowledge and the rest of the country has understood for quite some time now, which is that the Minister, Deputy Reilly, is not the man to lead the Department of Health?

The Taoiseach

Deputy Martin makes a comment and asks a question.

Deputy Barry Cowen

That is how it works.

The Taoiseach

The Minister of State, Deputy Alex White, is dealing with the area of primary care.

Deputy Michael Healy-Rae

We are back to the Minister of State, Deputy White.

The Taoiseach

His appointment to that Department has allowed him to focus on an element of the scheme for the introduction of free GP care for persons with long-term illness.

Deputy Timmy Dooley

Is the Taoiseach calling into question what Deputy Shortall did?

The Taoiseach

The Minister of State, Deputy White, quite rightly looked at the requirement for legislation in that area to deal with eligibility on medical grounds-----

Deputy Micheál Martin

It was promised two years ago.

The Taoiseach

-----and to deal with the administrative requirement to assess those patients. Previously, they have been assessed on income and on residency. In the long-term free GP care scheme, it will be based on medical assessment and medical grounds. The Minister of State, Deputy White, reported officially and formally to the Cabinet sub-committee that to do it piecemeal is not the way to do it and that he wanted to look at the entire scheme. He wanted six weeks to come back to the Cabinet sub-committee and say whether he was able to do this more effectively for the entire scheme and progress it more effectively. We gave him that authorisation and he will come back and report on his view of how it can be done more effectively.

Let me assure Deputy Martin, and the 56,000 people he refers to, that there is no question of the Government abandoning its commitment in the programme for Government to free GP care for these citizens and, ultimately, for the entire cohort of the population.

In respect of Deputy Martin's question about the Minister, Deputy Reilly, he is the Minister for Health and he has my full support in the strategy and the changes that are necessary to bring about a more effective health service. As Deputy Martin rightly pointed out when he had that responsibility, it takes longer to get things done in the Department of Health than anywhere else.

The Minister is focused on the requirement to change structures and the effectiveness of delivery of services in the Department. Primary care is a central element and being handled very effectively by the Minister of State, Deputy Alex White.

Deputy Gerry Adams

The Taoiseach's loyalty to the Minister is commendable, but he must know in his heart of hearts that his stewardship of the Department of Health has been an unmitigated disaster for citizens. Two issues emerge from the latest U-turn. One relates to citizens with long-term illnesses who have been let down by the Government, while the other relates to how the Dáil comes to hear about these matters. Teachta Caoimhghín Ó Caoláin has regularly asked the Minister about this issue, as have others. I have asked the Taoiseach about it numerous times in the past two years and he has told me that it is just a matter of time, that it will happen very soon. It is not credible that it took two years to discover these legal difficulties. What are the difficulties? We heard yesterday about the thousands of patients waiting four years for outpatient appointments. The issue of free GP care was the subject of a separate commitment from the Labour Party and Fine Gael before they even got to the programme for Government. It has been axed. People have been on waiting lists for four years. Clearly, there is an issue with the Minister. The Taoiseach clearly promised a universal, single-tier health service, guaranteeing access to medical care based on need. The cornerstone of that commitment was free GP care. Instead, we have a continuation of the two-tier system the Government inherited from Fianna Fáil. The Government has not even got past the first step in meeting this commitment to have a single-tier, universal health service. I understand the Minister of State is not answerable to the Dáil. It is the Minister for Health's responsibility. Will the Taoiseach spell out the steps he will take between now and the time people will have a chance to vote again to look after citizens with long-term illnesses and others who are in the high tech drug scheme and dependent on this type of support from the State? We should not have to wait to read about it in the newspapers. He should spell out now what steps the Government will take. As the Cabinet sub-committee on health dealt with this issue, it is a governmental responsibility. The Taoiseach is bound to know what steps he has in mind. Therefore, he should tell us.

The Taoiseach

I have already pointed out to the Deputy that the programme for Government sets out the steps that the Government will take across all Departments to rectify the public finances, sort out the problems we inherited and get the country back to work. I am the first to admit that there are a number of items in the programme for Government that have proved not to be deliverable, but this is not one of them. The Government has not made any decision to go back on the commitment to provide free GP care for citizens - those with long-term illnesses and, ultimately, the entire cohort of the people.

What I am saying to the Deputy is that the Minister of State is a lawyer and that he could see from looking at the structure in place that this would cause complex legal problems. He decided against getting involved in that jungle, focusing on it for a couple of months and bringing forward a service for 56,000 people that would require a legal base and teams to assess eligible candidates for assistance with long-term illnesses based on medical grounds, rather than residency and income, in the knowledge that he would need to move beyond that sector to others. I support him fully in that regard. It is right to say I want to look at the entire structure, my options and proposals on how we can do this more effectively in the interests of the people.

I have no idea how things find their way into the media. Sometimes, as Members know, they are sent deliberately, while at other times, they are fed by different people. I do not have any great interest in it, except to tell the Deputy, as I told Deputy Micheál Martin, that most of the story I read this morning - I did read it - is accurate, but the piece that is missing is that the Government has not made any decision to reverse its commitment in the programme for Government to provide free GP care. I support the Minister of State very strongly in that regard. Based on his legal background and knowledge of where it could lead in terms of administrative complexity, he is right to say he wants to report back to the committee by the end of May with a far more effective proposition on how to implement this commitment. It is about people, but it is also about delivering an effective and cost-effective system of best patient care under the proposals made. That commitment stands and will be delivered on, but it will be delivered on by a Minister of State who could see legal quagmires in the structure in place and who wants to change it and make recommendations to make it better.

Deputy Gerry Adams

The rub is that if the story was not in The Irish Times, we would not be having this conversation. Health spokespersons or spokespersons for the Opposition would stand up here and ask questions, only to be told that it would happen by the end of the year or before the summer. It would be difficult for the Taoiseach to say the Government had made a hames of it, but that is what has happened. The Government has had two years to sort this out. This relates to people with cancer, asthma, obesity and other long-term illnesses. What has happened to the money? I asked the Taoiseach yesterday about the money allocated for mental health care services and he promised to send me the figures. The figure was €35 million, but I am still waiting for the figures. What happened to the money allocated for this scheme? It was envisaged that extending it to those with long-term illnesses would cost €17 million. The Taoiseach did not answer my question about the legal difficulties arising and did not spell out what would happen in the meantime. In six weeks' time the House will go into recess and before we know it, the year will be over and the people in question will still be in dire straits. Why does the Taoiseach not spell out the steps he will take in the meantime?

Returning to the issue of the Minister, this is not personal. Of course, it is one of the most challenging Departments any Minister or Government could deal with. However, the Taoiseach must admit, if not here, then in his heart of hearts, that the Minister is making a complete mess of the commitments Fine Gael and the Labour Party were elected to fulfil. He should admit that he needs a new Minister and that we need a health system that works for citizens.

The Taoiseach

Now we know how the Dáil hears news because the Deputy has just announced that the summer recess will commence in six weeks.

Deputy Gerry Adams

Generally speaking.

The Taoiseach

Therefore, the Deputy only speaks in generalities.

Deputy Gerry Adams

Talk about the issue, please.

The Taoiseach

I will talk about it. I thank the Deputy for a premature announcement of the summer recess. Had he tabled a question without any story in the national newspapers or anywhere else, the answer would have been that the Minister of State was considering a number of other proposals to make the structure more effective. I would have told the Deputy the truth, namely, that the Minister of State would report back to the Cabinet sub-committee at the end of May with his very valid proposition that we could do this but that it would be administratively and legally complex, involving the setting up of panels of doctors to assess patients and the expending of much energy for a cohort of 56,000 people who were very important, without dealing with what would happen in the longer term. I support him fully in that regard.

I am sorry the Deputy did not receive the figures sought. I do not know whether it involved Pony Express or Wells Fargo, but the figures left the office and are somewhere between it and the Deputy's office. When he receives them, he will find that they are perfectly valid.

Deputy Gerry Adams

The important question is where did the money go.

An Ceann Comhairle

I call Deputy McGrath.

Deputy Patrick O'Donovan

The Deputy is a fair man to ask that question.

An Ceann Comhairle

Is your name Deputy McGrath? Deputy McGrath is up here.

A Deputy

Unfortunately, there is one up there too.

Deputy Ray Butler

A new Sir Alex Ferguson.

Deputy Mattie McGrath

In 1998, some 29 people, including a woman pregnant with twins, died when the dissident republican group, the Real IRA, detonated a car bomb which ripped through the County Tyrone market town of Omagh on 15 August. More than 200 people were injured in the blast. The attack was described as Northern Ireland's worst single terrorist atrocity and by the then British Prime Minister, Tony Blair, as an appalling act of savagery and evil.

At the 2004 Fine Gael Ard-Fheis, the Taoiseach promised that any government led by him would never lie about secret contacts with the Real IRA. More important, he saluted the families and the survivors of the Omagh bombing. He spoke directly to those families who were present: "You will get the truth and so will Ireland because Fine Gael is not alone in its commitment to honesty, honest politics and honest government." He further stated: "A government and its Ministers must keep their word because that is the standard should set and demand." Those families are here in the Visitors Gallery if the Taoiseach wishes to salute them.

We are familiar with the Taoiseach's report cards and score sheets for his Ministers. I hold him accountable today for his own scorecard and for what he promised. Representatives of the Omagh bombing families are here today in the Gallery, led by Mr. Michael Gallagher, who lost his 21-year-old son, Aiden, in the attack. These families have waited long enough for the full truth to be disclosed. On 19 July 2012, a comprehensive report was served to the Minister for Justice and Equality, Deputy Alan Shatter, calling for a full cross-Border public inquiry. To date, the families have had no meaningful response from the Government and neither are they aware of any actions that the Government has taken in light of this information.

Will the Taoiseach explain to the families today why there has been no meaningful response to the comprehensive report submitted to the Minister for Justice and Equality? Will he explain to them or even indicate to them what actions, if any, the Government has taken in light of the extensive and verifiable information presented by the families? If no action has been taken since last July, will the Taoiseach explain to the families why this is the case, given his previous acknowledgement that working to obtain the truth about Omagh was a duty he held in the highest regard?

The Taoiseach

The Omagh bombing was an appalling tragedy and an appalling crime. It was one of the worst tragedies inflicted on innocent people throughout the entire Troubles in Northern Ireland. I had some engagement with personnel who were involved on the fringes of the Omagh bombing. The information transmitted to me at the time was transferred to the Taoiseach of the day and to the appropriate authorities. I met with Mr. Gallagher when I was a member of the Opposition. I listened to his story and the stories of others. Last year, I asked the Minister for Justice and Equality, Deputy Shatter, to meet with the relatives and he did so. They handed him a copy of their report. The Minister has considered that report in part. Because of its implications, the Minister has not responded fully to the report as yet. On the question of the truth about Omagh, I would like to think we could find out the truth eventually. There are other issues in regard to Northern Ireland about which we have been unable to find out the truth. Some of these are very serious matters and people would like to be in a position to see the truth, however tragic, brought to light. I will ask the Minister for Justice and Equality to communicate with Deputy McGrath in respect of his ongoing consideration of the report he received from the relatives of the Omagh deceased. I met them only last year.

Deputy Mattie McGrath

I thank the Taoiseach for his reply. However, in order to find out the truth or anything else, one must look and examine. I do not doubt the Taoiseach's sincerity, even if I have concerns about the appalling pace of progress for the families and victims. I wish to make it clear to the Taoiseach that this is a case of significant State failings by successive British and Irish Governments. Last year the Taoiseach met the families of victims of the Enniskillen bombing and the Armagh massacre. I ask him to give half an hour at some stage to Mr. Gallagher and his people who are here today.

There have been failures on the part of both Governments in fulfilling their responsibilities under Article 2 of the European Convention on Human Rights. The families can no longer be fobbed off with the standard line about ongoing investigations. They are calling for a full and thorough investigation; it is what they deserve and need. It is what Ireland needs. There is a need to move forward with peace and reconciliation.

The Taoiseach is head of the Government. Will he give a solemn commitment to meet with these families? Almost a decade since his Ard-Fheis promise, they are still waiting for a full cross-Border inquiry. Will he commit to putting in place an effective process in which the families can be actively engaged rather than just politely listened to and then ignored? This has been the case to date. It is time we paid a little bit more than the usual political lip-service to the cause of these families and actually do something that will help them. It is action they need, not heartfelt sentiments that are soon forgotten while the families and victims linger for another 15 years without the full facts of what happened on that awful day being brought to light and to public scrutiny.

The Taoiseach

Some time ago I met some of the relatives of persons who were blown up in the Omagh tragedy. I met with the relatives of the Kingsmill massacre, with the relatives of those murdered in Enniskillen and with people from Fermanagh who were displaced, some of whom were shot. I have a long list of organisations and individuals of different persuasions and from different areas in Northern Ireland who want to meet me, among whom are the Omagh group. Before I meet such organisations I have a meeting in advance with officials from the Department of the Taoiseach. They will make the arrangement to meet with the Omagh relatives prior to my meeting them. In due course, I will of course be happy to meet with them, as I did before. The truth is what is required here. In Northern Ireland, with its sad legacy, the truth is outstanding with regard to a whole range of areas. It is not a question of making points about this; rather, it is a case of trying to deal with the fact that these people have to carry on their lives every day in the knowledge that a person or persons planted those bombs with the deliberate intent of causing murder and mayhem. That lingering emotion stays with those people every day until the truth is uncovered.