In his Private Members' debate speech, the Minister for Justice and Equality, Deputy Shatter, included information in the possession of his Department regarding Rehab lottery cards. This was the first time this was mentioned in the House and all Members are aware there is a pending High Court case involving Rehab and the State. There is no doubt but that this information is in the taxpayers' interest and everyone believes there should be value for money. In 2013, the Rehab Group received €2.5 million from the Exchequer in the charitable lotteries scheme, which was a reduction from the €3.9 million received the previous year. The group produces consolidated accounts that give combined activities of various businesses within the group and there undoubtedly should be more openness and transparency with regard to how the group spends its money, most of which is made from its business ventures that prioritise the employment of people with special needs. What is confusing is the motivation behind the release of information itself as the Minister, Deputy Shatter, did this intentionally during his Private Members' speech. In the first instance, Members must be conscious that more than 80,000 people use and rely on the services provided by the Rehab Group and that 3,800 people are employed by it. However, the key question is, what was the motivation behind the intervention by the Minister, Deputy Shatter? What was the motivation behind the Government's intervention? Is it concerned about misappropriation of funds? Is it concerned about the national lottery and the matching funding or what is the motivation behind the continuous spin in this regard? Does it relate to concerns about individual salaries or is there a broader concern about how Rehab operates? Alternatively, does the motivation pertain to the national lottery scheme and matching funding, which is provided for by the State or are there broader general concerns?
Leaders' Questions
Regardless of whether one is talking about Rehab, the Central Remedial Clinic, CRC, or any other charity, the first thing one must do is make it absolutely clear that the work these organisations do is very important. The people who depend on their services value the work they do and in whatever approach one might take or in anything one might say, one should be careful not to undermine public confidence in charities or to undermine the confidence people have in making donations to them. I do not believe the Deputy is correct in stating it was the first time the issue of the wind-down of the lottery payments had been raised in the House.
He did not say that.
I did not say that.
My understanding is that it was raised at an Oireachtas committee by Rehab itself. The issue is that when one is talking about the disbursement of public moneys, there obviously must be accountability for that. Under the charitable lotteries scheme established in 1997, the promoters of certain private charitable lotteries that have products similar to those sold by the national lottery have received annual payments from the State to supplement their income. The total annual funding available peaked in 2009 and 2010 at approximately €8.6 million. As the allocation of funding is based on gross ticket sales, the Rehab Group typically receives approximately two thirds of the funding available each year. The scheme now is being wound down and a reduced total of €4 million was disbursed in 2013, while the allocation for 2014 is €2 million. I understand the decision by the Minister for Justice and Equality to wind down the scheme was communicated to the relevant charities in October 2012. The scheme is being wound down over a three-year period to afford affected organisations the opportunity to make any necessary changes to their fund-raising activities to ensure they are more directly profitable. It is not unreasonable that the State would examine how it spends public money in supporting charities. Between 2011 and 2013, Rehab received €10.4 million in public money for its lotteries. If it is the case that the State is spending several million euro per annum to support fund-raising in the tens of thousands, then it might be better to consider whether those millions could be used elsewhere, for example, in front-line services.
The key point is that matching funding is provided in the context of the national lottery scheme for charities. This has been a common practice for many years and many voluntary or charitable organisations have been receiving matching funding. For example, sporting clubs nationwide receive matching funding in the context of other schemes; this is not unusual. However, I find it amazing that the Tánaiste is running out of adjectives to describe his shock that this information has been unearthed, when the information on the number of tickets sold on an annual basis was freely available in the Department of Justice and Equality for many years. The implication that the matching funding in some way is being misappropriated is almost the speak that is coming from the Government. What is the Government's concern and what is the concern of the Minister for Justice and Equality? Even though the State is before the High Court with Rehab with regard to compensation being sought by the latter, the Minister came into this Chamber to make what was a very unusual intervention, to say the least. The implication that this information was unearthed simply is not the case, as it has been sitting inside the Department of Justice and Equality year on year. I reiterate the key questions, namely, what is the concern of the Government and the Minister for Justice and Equality with regard to the matching funding being provided? Are there concerns there has been misappropriation of funding or is it simply a concern regarding insufficient openness and transparency?
Thank you.
In the meantime, while this spin from the Government is going on, it is doing untold damage to families nationwide who are depending-----
We are over time Deputy. Please, this is a supplementary question.
-----on Rehab services and other charitable organisations to supplement what the State should be doing. Effectively, that is the case here.
Thank you. Please resume your seat. I call on the Tánaiste.
Some straightforward openness and transparency is needed on the Government's side, as well as that of Rehab.
I remind Deputies this is Leaders' Questions and we put questions, not make statements.
Hear, hear.
First, this is not particularly new. As for the arrangement whereby State funding was provided to certain organisations that were running lotteries, the decision to wind down that funding over a three-year period was communicated to the organisations back in 2012. It is being done over a three-year period and as I stated, at the peak in 2009 and 2010, it involved a sum of €8.6 million in total that was being paid to such organisations. It was decided to wind that down over a three-year period to give the organisations the opportunity to make other arrangements, including other fund-raising arrangements, and so on. This has been ongoing for some time and so there is nothing new in that. In the course of the debate here in the Chamber the other evening, the Minister for Justice and Equality drew attention to what was happening in that area. At a wider level, the Government must ensure the controversies that have arisen around some charities in recent times do not undermine the important work those organisations do and the services they deliver-----
Thank you.
-----which in many cases are delivered on the basis of payments provided by the State. Second, it must ensure the controversies do not undermine public confidence in them. This is the reason the Government brought in legislation to provide for a charities regulator. This is the reason the Government is proceeding with the putting in place of that regulatory regime and it is the Minister's intention that this will be in place, hopefully, by the end of February.
Today, one again can see the lack of regulation of charities in this State, as well as the untold damage the revelations are doing both to the charities themselves and to the citizens who depend on them. The Government has refused for three years to implement the Charities Act 2009 and again last night, its Members voted against the Sinn Féin Bill, which would have resulted in a supplementation forthwith. Ongoing revelations of excessive pay to charity chief executive officers, serious questions over fund-raising, and a lack of transparency and accountability have deeply angered citizens, particularly those suffering at the end of the brutal austerity cuts in recent years. I believe what has been uncovered at the CRC, Irish Water, Poolbeg and elsewhere is a toxic political culture of top ups, bonuses, jobs for the boys and contracts for the elite. Again, one reads in the newspapers today of a former chief executive officer of Rehab and long-time adviser of Fine Gael billing the company for consultancy services using a dissolved company.
That all suggests something rotten in the state of Denmark. CRC had very close links with Fianna Fáil.
The upper echelons.
Is it appropriate that the head of a charity earns more than the Taoiseach of the country and ten to 20 times more than those who are on social welfare? Does he agree that the CEO of Rehab should reveal her salary? Does he agree with the call from the Committee of Public Accounts that such charitable organisations should make full disclosure on such matters?
This Government is actually implementing the Charities Act and establishing a charities regulatory authority, precisely so public confidence in charitable organisations can be assured. In December, the Minister for Justice and Equality got sanction from the Minister for Public Expenditure and Reform to proceed with the filling of the post of CEO of the new charities regulatory authority and a number of other administrative posts from within existing resources by the end of February. The Minister is issuing a call for expressions of interest from suitably qualified persons who wish to be considered for appointment with a view to having these positions filled by Easter. This will enable the authority to proceed with the preparatory work necessary ahead of its formal establishment by ministerial order later in the year. The focus of the new authority in its early phase of operation will be on the preparation of a statutory register of charities for publication.
This move represents an important part of the work we are doing in government to rebuild trust and confidence in our charity sector. The charity sector can show leadership in this area through demonstrating good governance and transparency in its own operations. It is important we underline again the good work charitable organisations are doing. It is important that the public can have confidence that when they make a donation to a charitable organisation it is going for the purpose for which it is made and is going into the services. That is why we will have a regulatory system and authority for charities in place. It is the intention that the key posts will be filled by the end of February and that the authority will be in place by Easter. That work is proceeding and there will be a regulatory regime.
I am in favour of transparency. I am in favour of organisations making known in their accounts the salaries they pay to their CEOs. I see no reason salaries paid to senior people in charitable organisations or other bodies should not be made available by way of public information.
The root of the issue is the chaotic mix of public, private and charitable provision of health services in this State which has been allowed to develop over successive Governments, including previous Governments in which the Tánaiste has been involved. This has allowed charitable organisations to provide core health services. Those Governments, and the current one, must bear significant responsibility for the situation. While the State has provided much of the funding, an arm's length relationship allowed poor accountability to flourish. In St. Vincent's hospital there was one chief executive for both the public and private hospitals. Considering the amount of public money that has gone to support the activities of Rehab, does the Tánaiste agree that it would be more cost-effective for the services it provides to be provided directly, as they should be, by the State?
This Government is getting to grips for the first time with what is happening in organisations which are funded by the State and where issues have arisen regarding salaries that are paid or governance. It was this Government that commenced the audit, through the HSE, of the various organisations funded by the State, and that audit shone light on the salary levels and various other arrangements. We are putting in place the regulatory regime I have described. Progress has been made on that. The relevant staff will be in place by the end of February and the authority will be operational by Easter. That will be the first time that will have been done.
It is the Government's view that there must be accountability for the spending of any public money, and that it must represent value for money and the best outcome for the taxpayer. If we feel public moneys can be better used, more effectively deployed or can deliver a better service for the public by means other than channelling that money through particular organisations, that will inform our policy decisions. Our view is guided first by the need for the public to get the best possible service for the spending of any public money irrespective of how it is spent, whether through a State agency, a voluntary agency or a charity; and second by the need for transparency around the way taxpayers' money is spent. That is why we have taken the approach we have taken and we will continue with that until there is a satisfactory outcome to all these matters.
As part of the recent reconfiguration of Dublin hospitals, the emergency department at St. Columcille's Hospital, Loughlinstown was downgraded to a minor injuries unit and 24-hour care was stopped. I, and many others, supported these changes because the clinicians leading the reconfiguration unanimously believed that it would save lives. The HSE gave us repeated assurances that St. Vincent's University Hospital would be given sufficient resources to absorb the extra workload from Loughlinstown hospital. Despite these assurances, the following letter appeared in The Irish Times from a registrar in St. Vincent's:
The real scandal at St Vincent’s University Hospital is the overwhelming increase in acutely unwell patient volume since the effective closure of St. Columcille’s Loughlinstown to out-of-hours admissions. [This] has led to a doubling of medical and surgical admissions to an already stretched but otherwise efficient and well-run public hospital. Clinicians of all grades and disciplines are working flat out to cope with the increased demand.
I followed up with clinicians in St. Vincent's and they said ambulance arrivals and GP referrals to the emergency department there are up approximately 50%. Overall admissions are up approximately 50% and have doubled in out-of-hours. They say that in spite of this the emergency department has received no additional nurses and only a token complement of doctors. Just last week staff that were promised from Loughlinstown to St. Vincent's have been pulled, so the emergency department in St. Vincent's is dealing with a 50% increase in volume with only a handful of extra medics, contrary to the assurances we were all given.
That is not the only problem. St. Vincent's has not been given the additional ward beds to deal with the additional volume either. Patients at Loughlinstown who become very sick are referred directly to the intensive care unit in St. Vincent's, which is also bringing that to over-capacity, according to the medical staff there. Not only is the emergency department working flat out, there is nowhere in the hospital for them to send the patients once they have stabilised them. The letter ends: "The end result is an unsustainable, overcrowded and unsafe mess with significant compromise in delivery of care." Patients are suffering and some will die.
This is outrageous. It is unacceptable to me and I have no doubt that it is unacceptable to the Tánaiste that this has happened. Why have the additional resources, which we were promised would be put in place, not been put in place? Why has a situation been allowed to develop in St. Vincent's hospital which clinicians are now telling us will lead to patients in the Tánaiste's constituency, my constituency and many other places dying?
As the Deputy is aware, prior to the changes taking place between Loughlinstown hospital and St. Vincent's University Hospital, I convened a number of meetings with the HSE and the managements of the two hospitals. I invited the Deputy and other Deputies who had expressed an interest in this issue-----
Not me.
-----because the Deputy had not expressed any interest in the issue to me. He is only interested in standing outside the hospital with a picket; he has no interest whatsoever in solving the problem.
We were leading the protest and I warned the Tánaiste what would happen.
As Deputy Stephen Donnelly knows, we convened meetings with the managements of the HSE and the hospitals to discuss their plans. Arising from what the Deputy has just read, I will arrange another meeting-----
Will the Tánaiste arrange meetings around the country?
-----and ask the managements of St. Vincent's University Hospital, Loughlinstown hospital and the HSE to address the issues he has raised. I would share his concern if the service was not being adequately delivered. I am a little surprised at the increase of 50% in the number of ambulances-----
There are 21,000 cases a year.
-----because prior to the changes at Loughlinstown hospital for a period of two years or more trauma cases had been going directly to St. Vincent's University Hospital. However, I take these issues seriously and will ask the HSE and the hospital managements to meet me again to discuss the issues involved.
I appreciate the Tánaiste's offer to set up a meeting. However, I suggest a meeting is probably not enough at this stage. We have been given many assurances. I was given an assurance by the HSE that the combined budgets of the three hospitals involved, St. Vincent's University Hospital, Loughlinstown hospital and St. Michael's Hospital, would increase as part of the reconfiguration. One year later I was told that not only would the budget not be increased, it would be decreased. We were given assurances regarding the timing of when this would happen, but they did not come to pass. Now we have an extremely serious situation where a medical registrar and medical staff are saying people will die. They are telling us the assurances we were given by the HSE have not been met.
Can we, please, have the Deputy's supplementary question?
I suggest to the Tánaiste that while having a meeting is fine, because the allegations are so serious, we need an independent and urgent review. I do not know whether the 50% figure is correct, whether ICU is operating at overcapacity, whether GPs are referring patients or whether there has been a doubling of admissions out of hours, but we need an urgent and independent review. I have two requests to make of the Tánaiste. I thank him for saying he will arrange a meeting, but as well as this, will he ask that an independent review be commissioned immediately and a report provided? Will he also commit that if the review finds that the allegations have substance and that the necessary resources have not been provided for St. Vincent's University Hospital, the Government will provide them immediately?
The first thing we must do is probe the facts to establish the position. It might be a good idea to ask the registrar concerned to come and tell us directly and probe the issue and statements he is making with the managements of the hospitals. We must establish the factual position. We can then set about resolving the issue. The outcome we want is to have is the highest level of service being available to the public. The Deputy mentioned beds. I understood beds in Loughlinstown hospital were to be used for elective cases which would, in turn, free up beds in St. Vincent's University Hospital and enable a throughput of patients through the accident and emergency service. The Deputy is aware that by the time the changes were made in Loughlinstown hospital, the numbers attending the accident and emergency ward at night were very small, because for some time if an accident occurred on the N11, for example, the patient was brought directly to St. Vincent's University Hospital. I would like to probe the facts to establish the position. We can do this and, if necessary, then ask the registrar who has written about these matters to come and give us the information he has available.