Léim ar aghaidh chuig an bpríomhábhar

Dáil Éireann díospóireacht -
Wednesday, 5 Mar 2014

Vol. 833 No. 2

Government's Priorities for the Year Ahead: Statements (Resumed)

We are here today as part of the three-day festival and orgy organised by the Government to congratulate itself-----

I remind the Deputy about unparliamentary language and ask him to use language with decorum.

I will start again. We are here today as part of the three-day festival of praise and self-congratulation by the Government to tell the people how wonderful it believes it and the job it has done have been. It is on a different planet from the people on the ground. This three-day debate is part of the Government's ongoing effort to have spin and PR triumph over substance. To some extent, this has been one of its main successes. The substance of what the Government has done does not fully stack up but its PR, press announcements and media coverage would have one believe it is doing exceptionally well. The Government has planned this debate well in that it is allowing three days of marathon coverage for every Minister and Minister of State, thus affording them the opportunity to pat themselves on the back in the House and write glowing self-congratulatory scripts in the hope some of the media will regurgitate their comments over the coming week in various radio and television programmes. Some people might be convinced that it is doing a great job.

I listened carefully yesterday to the Minister for Public Expenditure and Reform, Deputy Brendan Howlin. He referred in his speech to expenditure consolidation. He stated: "The expenditure measures required for 2014 amount to €1.6 billion out of a total consolidation requirement of €2.5 billion.” He is, therefore, confirming that €1.6 billion of the budget’s consolidation requirement of €2.5 billion was achieved through expenditure cuts. This amounts to 64%, which is as close as makes no difference to two thirds of the adjustment being made at the expense of people who are relying on public services and those who need those services most.

I have always said on this side of the House that no matter how difficult financial circumstances are, the adjustment should always be achieved in a fair manner, applying a 50:50 ratio. There should be some additional taxes on those earning over €100,000, who can afford to pay more, and, unfortunately, some reductions in expenditure in line Departments with large expenditure headings. For a Labour Minister to say two thirds of the adjustment has been achieved through expenditure cuts is surprising.

Absent in the Minister's script yesterday was the word "fairness". The Labour Party, in government, has sold its soul by going into government with a right-wing Fine Gael Government. We have a very right-wing Government under Fine Gael, which is fine because a certain number of people voted for that party. People know the form of the party and that it does not want to tax higher earners. It has not made provision for this. My issue with the Minister for Public Expenditure and Reform, whose script I am responding to, is that I do not understand what the Labour Party is doing in government at all. It should let Fine Gael get on with the Fine Gael agenda. The Labour Party is not even the mudguard for the Fine Gael vehicle in government. It should have the decency to let Fine Gael do what it wants to do, which is what is being done. The Labour Party is trying to provide some cover of decency over what is being done but the people will judge it not on the PR spin, which it is very good at, but on the substance of what it actually does.

The Minister for Public Expenditure and Reform, who stated two thirds of the adjustment was achieved through expenditure cuts, has hit the people who are relying on the health service the most. Waiting times for appointments with consultants and outpatient appointments have skyrocketed in the past couple of years. Pupils in primary school cannot obtain orthodontic appointments. There are cuts affecting medical cards, not only for those over 70 but also for those who are the most vulnerable and require a medical card on health grounds. There has been a dramatic reduction of 40% in respect of the discretionary medical card. We witnessed reductions in the pupil–teacher ratio and major cuts by the Department of Social Protection. There have been cuts affecting the elderly, such as that to the telephone allowance. Many other entitlements have been taken from the elderly. There have been severe cuts to payments for young people and a reduction in their jobseeker's allowance. The latter is part of a deliberate policy of forcing young people to emigrate, as tens of thousands are doing. The Minister will say the number on the live register is decreasing. This is because many people who were on it are now in Australia, New Zealand, Canada, England and elsewhere.

I have outlined the key financial parameters that the Government has been working on. I do not understand how the Minister for Public Expenditure and Reform, as a member of the Labour Party, can stand over them. He trumpets the great changes he has made to freedom of information procedures. Again, he has succeeded in having spin triumph over substance because he is retaining every single charge that was ever introduced in freedom of information legislation. He criticised the outgoing Government for introducing such charges and said he would totally reform freedom of information procedures. Not only is he retaining every single charge introduced but he is also introducing new ones for search and retrieval of a scale not even envisaged in the current legislation. He is selling this as a victory.

The Minister excluded Irish Water from the freedom of information legislation. As a result of pressure applied by Fianna Fáil, he was forced to do a U-turn. He said "No" at a committee meeting but we forced him to change his mind in the Chamber. He made a humiliating U-turn, albeit a good and proper one. We will force him to make a similar U-turn to bring EirGrid under freedom of information legislation. It is unbelievable that he is still standing over the current position. Fine Gael and the Labour Party will be voting on the matter in this Chamber when Report Stage is considered. The Opposition will succeed in forcing the Government to bring EirGrid under freedom of information legislation. I do not know how the Government could go before the people in local or general elections while refusing to apply freedom of information legislation to EirGrid in view of the gross incompetence of that organisation.

One of the triumphs the Minister for Public Expenditure and Reform mentioned in his script concerned public service savings achieved from 2009. Most of the savings actually achieved were in 2009, 2010 and 2011, before the Minister took office and before his Department was even established. He takes credit for the various savings since 2009 but the most important aspect of the Croke Park agreement for public servants was that there was an external mechanism to verify the savings that were being achieved.

The Minister has abandoned this and, by way of a lack of transparency, has ensured there is no external mechanism to verify the savings that will accrue under the Haddington Road agreement, the successor to the Croke Park agreement. This is a serious flaw. He talks about openness and transparency, but one can see that he is concealing and preventing access to information which previously had been available under the Croke Park agreement. He abolished this in the Haddington Road agreement, which means that there will be no external verification.

With regard to procurement, the Department exported 5,000 Irish jobs last year by offering contracts worth €650 million to companies from outside the State. If the Minister of State, Deputy Brian Hayes, were a Minister in France or Germany, he would not do this but would give the contracts to domestic companies.

The Minister has spoken about whistleblowers legislation. We received a report from the Comptroller and Auditor General dealing with the fixed charge fines for driving offences and saw the attitude of the Minister for Justice and Equality and the Garda Commissioner to the whistleblower in that instance. This is reflective of the attitudes of the Government. However, we will make it change its view on whistleblowing in the Garda Síochána and force it, by way of voting in this House, to allow people to bring their concerns directly to the Garda Síochána Ombudsman Commission.

The essence of the Government's idea of political reform is to grab all power for central government. There has been a power grab by the Government. The first thing it did on taking office was to abolish democratically elected local authorities around the country, town councils that were effective in providng for local participation in local decision making. It then proceeded to hold a referendum which, thankfully, the people rejected and which would have given the Government more power through the abolition of the Seanad. It has absolute control in this Chamber and does not want opposition in the Seanad, where it does not have such absolute control. The people gave it their answer and its power grab in that respect was rejected. It also held a referendum before that, which was proposed by the Minister for Public Expenditure and Reform, Deputy Brendan Howlin, to provide for Government-controlled Oireachtas inquiries, but the people, rightly, said "No" because it did not trust Government-controlled Oireachtas inquiries to make findings.

There has been a complete insult on the sale of State assets. A sum of €200 million has been received for the sale of the national lottery in the next couple of months. The Minister promised the Dáil that this money would be used for the national children's hospital, but he has put it in a slush fund for Fine Gael and the Labour Party for the local elections campaigns. The spend is €200 million willy-nilly around the country from that slush fund. That is political reform.

I note that the Taoiseach, in a display of faux modesty, refused to mark his Government's score card. He was probably wise to make that decision because the role of an effective Opposition is to hold the Government of the day to account, which means that it is our job to score the Government's card. Perhaps more importantly, it is the job of citizens to make decisions on the scores.

On taking office the Government's job was never going to be easy and it is important to acknowledge this. Decades of Fianna Fáil short-termism and self-interest had resulted in a catastrophic shock to the economy in advance of the 2011 general election. The challenge for any new Government was always going to be immense, but it was also an incredible opportunity to challenge the fundamental faults in the political system. For the first time in the history of the State, half of the Members elected to the Dáil were first-time Members. There was a brief glimmer of hope things might change and change absolutely for the long term. Fine Gael and Labour Party spin doctors captured this mood by opening the programme for Government with the sentiment that a democratic revolution had taken place, with old beliefs, traditions and expectations blown away. To this day, reform remains the mantra of the Government, yet little of the fundamental reforms, cultural changes or fairness for which people had voted has materialised. To all intents and purposes, Fine Gael and the Labour Party took up where Fianna Fáil had left off. Both parties' election manifestos were set aside and Fianna Fáil's so-called national recovery plan was adopted.

One example is the Government's decision to introduce domestic water charges. In 1996 the then Minister for the Environment, Deputy Brendan Howlin, abolished domestic water charges. Speaking in 2004 on the Water Services Bill the Labour Party leader, Deputy Eamon Gilmore, described the legislation as a thinly disguised attempt to privatise the water supply and also as an attempt to reintroduce water charges by another name. He reprimanded Fianna Fáil by describing ministerial oversight of the water services strategic plan as a pretence of public involvement or democratic accountability. In its 2011 election manifesto the Labour Party explicitly told voters that it did not favour water charges. Now, however, it will be responsible for the introduction of domestic water charges, a method of taxation which is, to use its own description, deeply inequitable. Irish Water is not properly accountable to the Oireachtas and extracting information on the company from the Minister is a painful and frustrating exercise for all involved.

In the midst of all of this, where is the promised reform? Where is our new day? The truth is that there has been little reform. The Minister for Public Expenditure and Reform has kept his focus fixed solely on the bottom line. His contribution last night reflected this again, as he set out the Government's consolidation or cutback requirement of €2.5 billion in 2014. Both he and the Government refuse to concede that the measures set out in the public service reform plan are, at best, modernisation. They do not represent profound reform. The Minister, like his Cabinet colleagues, has continued the work of Fianna Fáil by indiscriminately savaging public sector numbers, a policy that he knows has back-fired and from which he is now quietly, if belatedly, backing away.

Health provision, among other service delivery areas, has particularly suffered. Mental health care services, for example, are not adequately staffed and this is a direct result of the Government's 2012 incentivised retirement scheme for the public sector. Medical card probity, a term that emerged in the last budget, was the Minister, Deputy Brendan Howlin's brainchild. In advance of the 2014 Budget Statement it appears that he literally plucked a figure out of thin air to balance the books. That is not so different from what Fianna Fáil would have done.

Far from improving the capacity of small and medium-sized enterprises, SMEs, to tender for public sector contracts, the Department of Public Expenditure and Reform is acting as a blockage to the sector in many instances. There is no joined-up approach between that Department and the Department of Jobs, Enterprise and Innovation. Government contracts are worth billions of euro to the local economy, but small and micro enterprises are not getting the hearing they need from either Minister. Social clauses are still not a staple of Government procurement contracts and, to date, it has offered no sensible argument as to why this is the case.

Political expenses are still not fully vouched. Where is the radical extension of the parliamentary questions system? Freedom of information legislation has still not been restored to its former glory and the last time the legislation was brought before the House the Minister, Deputy Brendan Howlin, endeavoured to pull a fast one on the issue of charging for freedom of information requests. The Government talks the talk on open data, but it has yet to walk the walk. Oversight bodies are not adequately resourced and public data collection and sharing have still not met 21st century norms.

Corporate governance is still woefully inadequate.

The work of the Committee of Public Accounts on the charitable sector has exposed some of this. However, it appears the Cabinet is still in no rush to tackle the systemic cronyism which exists among a very small number of people in publicly-funded bodies.

Reforms, rare as they are under the Government, only happen in an environment of crisis. The Cabinet decided to set aside the long-awaited regulation of the charities sector until a crisis emerged and the public demanded action. The Cabinet also decided to set aside the programme for Government commitment to introduce consolidated and reformed domestic violence legislation. I raise this issue as we approach international women's day on Saturday. The IBRC legislation, which included the waiving of property rights, could be rushed through the Dáil in a matter of hours but there is still no urgency when it comes to protecting women and children from domestic violence. The Government has not yet signed up to the Council of Europe Convention on Preventing and Combating Violence against Women and Domestic Violence. It argues that Article 52, which provides for emergency barring orders, infringes on property rights under the Constitution. Property rights can be waived when it comes to socialising bad bank debt but not when it comes to protecting women and children. This is some reform. The Labour Party's election manifesto promised to tackle and eradicate domestic violence. It promised to protect front-line services such as family refuges, but we know from statistics that incidents of domestic violence have increased and women with their children are being turned away from refuges due to a lack of places.

A raft of promises was made on equality but the Government is not pursuing gender quotas on State boards. It is not even delivering them on its own benches. The Government committed to requiring all public bodies to take due note of equality and human rights in carrying out their functions, but it refused to take up equality budgeting and voted against the provisions of same.

The Government promised to promote social inclusion, equality, diversity and the participation of immigrants in the economic, social, political and cultural life of their communities, but it stands over direct provision. Nothing has changed for the Traveller community. The Government drags its heels on the little it has promised to some, not all, survivors of the Magdalen laundries and has turned its back completely on the men and women who survived the Bethany Home. The issue of illegal adoptions has yet to be grappled with. Louise O'Keeffe was forced by the State to take her case to Europe and last year the Cabinet argued the State had no liability for what happened to children while attending primary school. It is not so different from Fianna Fáil. While members of the Government clap each other on the back and wax lyrical about budget consolidation, doing more with less and the wonders of shared services, the reality is the Government is not so different from the last.

I am disappointed the Government has decided to turn over the Dáil this week to host a backslappers convention for itself. It is quite embarrassing. I would have thought Fine Gael had enough of that at the weekend but clearly the Labour Party felt a bit left out. Many people in Irish society would like to slap members of the Government but I am not sure it would be on the back. If I were in government I would be hanging my head in shame at the litany of broken promises it has stood over. None is more apparent than the appalling treatment of young people. The Government's solution to long-term unemployment is to frogmarch people into the Gateway scheme of working for nothing for the local authorities. The 3,000 local authority jobs axed in the past year will be replaced with young people or other long-term unemployed people working for nothing. What future does this hold for people?

The Government has relied overly on the private sector and the fruit of its labour is the number of companies which have closed down in recent years. Long-standing good-quality jobs have been eliminated from the economy. The idea the Government would compound this by undermining the public sector is absolute lunacy. Opportunities which were there for people when they left school to take up a secure, permanent pensionable job at the local authority are being eliminated and replaced by what is, in essence, a chain gang. This at the same time as we have, in Ireland, the highest profits being earned in any location in the EU but the lowest level of investment. The only investment happening in this country is buying up distressed properties for knockdown prices. Unless the Government addresses this and deals with the issue through a public investment programme we will not see an end to dealing with the issue of unemployment.

There are many issues and we have little time to grapple with them. We could be here all day. Fine Gael could not care less about the flights at Shannon Airport, but the Labour Party in government has stood over a 79-year-old woman spending her second month in jail for having the audacity to highlight how Shannon Airport was being utilised by the US military machine. The State refuses to examine a single aircraft there.

The democratic revolution and the new era of transparency and accountability which the Government promised us has been absolutely and utterly exposed. We could be here all day pointing out examples but I will give several in the limited time available. How we treat individuals and the most vulnerable in society is usually a pretty good measure of whether we have things the right way around. Particularly from the point of view of the Labour Party, which made a virtue in opposition of being better and more humanitarian and liberal, the record of the Government is a particular affront.

At the weekend the Taoiseach stated he would not allow anybody in the State to undermine An Garda Síochána. He is a little bit late for this because unfortunately his Minister for Justice and Equality and his Garda Commissioner have done a pretty good job of it already. The Government's handling of the recent Garda controversies has seriously undermined the good gardaí trying to do a decent job. It has undermined the confidence of the public. It has some limited time to address these issues.

Deputy Wallace will expand on some of these points later but I want to highlight some of them. Over the weekend there were revelations in the media about information about Traveller children being put on the PULSE system. I raised this issue with the Minister for Justice and Equality late last year. His answer at the time was pretty much his answer to everything; he stated he asked the Commissioner and was assured by him that An Garda Síochána does not engage in discriminatory ethnic profiling. This is not enough for the Traveller community which has heard allegations that a 16 day old child was put on the criminal intelligence system with a separate number. I am sure the Minister for Children and Youth Affairs will be concerned to know whether other Traveller children or adults have been put on the criminal intelligence PULSE system without any reason or alleged criminality. This needs to be investigated.

The Minister, Deputy Fitzgerald, and the Minister of State, Deputy Brian Hayes, are probably aware of a report into racist incidents in the latter months of last year, which dealt with the real experience of people at the hands of the Garda. During the three-month period just short of 100 racist incidents were reported but only 16 were reported to the Garda. Of those who did report to the Garda their experience was not pleasant, and the original abuse was compounded by the fact their complaints were not addressed properly and by poor levels of communication. Incidents were reported where gardaí told a man his car was probably broken into by Travellers, and gardaí questioning somebody with a Traveller-identified name went into the person's background and ethnic status. These issues have been well documented and the Ministers need to address them.

Unless one is looking after the sections of society that are most discriminated against, one is not looking after anyone else either.

There are a number of other cases on which I wish to touch briefly. The Ministers are aware that last week Deputy Boyd Barrett raised the appalling case of Cynthia Owens and the murder of her young daughter, which occurred a number of years ago, and the need for that case to be investigated. I echo that call today. Again, if one wants to mark a new dawn in our society, we must address these crimes of the past. Sadly, however, it is not only Cynthia Owens who was abused sexually as a child for a number of years. Sarah Bland experienced a similar trauma in that regard, whereby she was systematically abused and raped by her father in a case that came to international prominence because a number of Members of the Northern Ireland Assembly in particular took up her case. That woman and her mother, who are in Ireland today, have fought a campaign over decades to get justice. She is appalled by the fact that the solicitor in her case is now the Minister for Justice and Equality and yet at that time left her in a situation where her complaints were not listened to and she suffered further abuse for years. These are serious issues and we cannot brush them under the carpet. There are too many of them and people need answers in that regard. The last case I will mention is that of Frank Mulcahy, who experienced multiple complaints in respect of various Garda assistant commissioners. In fairness, the Minister for Education and Skills, Deputy Quinn, has stated that this man needs justice. The case of this man having his good name impugned by the State must be answered. While I do not have the time to deal with these issues, unless they are addressed, they will not go away.

As the Minister for Health is present in the Chamber, I will make a final point in respect of medical care. Members used to talk about looking after people from the cradle to the grave but the recent crisis in a maternity unit shows people should be looked after before they get to the cradle. The hollowing out of the public service and the removal of experienced staff from the health system has led to unsafe practices in the maternity hospitals and beyond, and there is a need to address the numbers. The Government's proposed GP scheme for children under six is a stunt. It is an insult, which clearly has encountered a severe backlash from GPs. The Minister will be aware of a doctor in our constituency of Dublin North who has recently taken up practice having come from the NHS in Britain. The aforementioned doctor took over this practice from another doctor, who committed suicide with a waiting room full of patients because of the financial and stressful pressures the medical profession is under.

How dare you speak of a friend of mine without knowing the facts?

This doctor, who has taken over the practice------

While I had some admiration for Deputy Clare Daly, I have none now. I am shocked.

These are serious issues-----

He was a friend. I am shocked that the Deputy-----

-----and this doctor, who has taken over the practice-----

I remind Deputy Daly regarding privilege-----

-----would upset his family-----

-----and referring to people who are not in the House.

I will explain.

-----and would use this Chamber to make such statements.

Thank you, Minister. I will chair-----

This doctor, who has taken over-----

Sorry; I remind Deputy Daly regarding privilege and naming people who are not in the House.

I am appalled. This is such an abuse.

In a letter sent to his local Deputies by the aforementioned doctor who currently is operating this practice, he stated that he had worked in a properly resourced, free-at-the-point-of-care general practice in the United Kingdom for years. Consequently, universal health care is not the problem.

Thank you, Deputy. Your time is up.

The problem is the manner in which the Department is implementing this measure-----

-----without the proper consultation or safety measures for doctors, who already are hard pressed and will not be able to deliver a level of care for their patients. This is a stunt-----

-----that will not improve the position for people, but again, it is indicative of the poor record of the Government.

I call the Minister for Health, Deputy Reilly, who is sharing time with the Minister for Children and Youth Affairs, Deputy Fitzgerald. The Ministers will have ten minutes each.

I wish to place on the record of the House that the doctor mentioned by Deputy Clare Daly was a fine doctor and a great friend of mine. There were many factors that led to the tragedy and I apologise on her behalf and on behalf of this House for any upset she may have caused to his family.

I think the Minister is the one who-----

Thank you. We will have one speaker, please.

It is clear that 2014 will be a very challenging year, perhaps the most challenging for the health services. However, as a country, we have made significant progress since the Government came to office in March 2011. I wish to reflect on the progress made and to outline the Government's priorities in the health sector for the year ahead, which is not to ignore the real difficulties that remain and the hardship that people have been obliged to endure. The Government inherited an economy in free fall and a health service in crisis. It has since stabilised the economy, as it has stabilised the health service. Just as the Government seeks to implement fundamental reform in the economy to boost job creation and make Ireland the best small country in which to do business, it is implementing fundamental reforms of the health services to provide the people with a health service that has the needs of the patient at its core.

Ireland has some of the best doctors and nurses in the world. Moreover, some of the best managers in the world are Irish. Therefore, the question is: why do we not have the best health service in the world? I believe Ireland can have one of the best health services in the world, but to achieve this, the service must be reformed. It must be reformed in a way that allows those who work in it deliver the excellence with which they have been trained and that they wish to deliver. Reform is critically important but so is making a difference today for today's patients. That is the reason my first priority on taking office was to tackle the issue of trolleys in emergency departments and to tackle waiting lists in outpatient and inpatient departments. I am proud to report on behalf of the health service that there has been a 95% reduction in the number of people waiting more than 12 months for an outpatient appointment. In addition, a 33% reduction in the number of patients who must endure long trolley waits was achieved between 2011 and 2013, with a 13.4% reduction between 2012 and 2013. The present Administration is the first Government to actually quantify the number of people waiting on an outpatient list. As I have stated, now that the Government has this information, it can target resources and implement innovative solutions to address these waiting lists, because, quite simply, unless one can identify and quantify the problem one has no chance of dealing with it.

Given the economic situation, it has been imperative for the Government to reduce costs, and this has been done. Savings measures of approximately €3 billion have been made and staff reductions of approximately 10% have been implemented, while all the time maintaining services. While I acknowledge that other areas of the public service have been obliged to put in place similar plans to achieve the Government's fiscal targets, as Minister for Health I am particularly proud of how the health service staff have responded to this challenge and of how the men and women who work in the health service on a daily basis continue to deliver safe care despite the challenges they face. I wish to place on record my support for them. The Government also has sought better value for money for patients and the public by reducing the costs of drugs and medicines. Again, it has done so in a sustained and planned way through legislation on reference pricing and generic substitution, and by so doing, it has cut the costs for the customer while maintaining quality and safety. Moreover, the Government has not just cut costs for today but has done so for tomorrow.

I have mentioned a patient-centred health service and that is the reason that in 2014, the Government intends to establish a patient safety agency on an administrative basis. I am pleased to state that the advertisement for a chief executive officer for the aforementioned agency will be placed in the press this week. The patient safety agency will support patients in securing an appropriate response to issues or complaints they raise about safety or any other complaints they may have. Patients will have an advocate who will act on their behalf and help them by directing them on how to pursue their complaint and to get satisfaction for that complaint. From my 30 years of experience as a doctor I know that when things go wrong, what most people seek is an apology, an acknowledgement that something wrong happened and an assurance that it will not happen again because things will change. This is what the purpose of the patient safety agency will be, but it will also promote and disseminate lessons from complaints nationally. The Government is also preparing the way for a licensing system for both public and private health service providers, which will put in place a framework for enhanced accountability and monitoring, and this licensing authority will have teeth.

It is often said to me that one can be sitting in a restaurant about to enjoy a meal when an environmental health officer can come in, take the plate from under one's nose and say he or she is closing the place down as it is not safe to eat in, yet we do not have a similar system in place for hospitals, or departments of hospitals, which have not been safe. We need to ensure that system is in place, particularly when it comes to private facilities which are unlicensed and for which we have very little remit.

Since 2011 we have cut the cost of health care for patients and the public and reduced expenditure on health services, while reducing waiting times and numbers and maintaining patient safety and quality, but this is not enough. The population faces significant public health threats not just to this generation but to future generations also. Obesity and the misuse of alcohol and tobacco are not just individual threats, they represent public health risks which will consume us if we do not address them at a strategic level in a planned way. That is why we published Healthy Ireland, our strategy for improving the health of the people and enhancing health and well-being. It is an ambitious strategy which aims to embed health and well-being across public policy and services. A healthy population is a productive one and clearly it is cost efficient to combat public health threats through initiatives such as Healthy Ireland rather than through the health care system, which would be unsustainable and not fair. I will give the analogy of investment in fire tenders, ambulances and all of the personnel at the bottom of the cliff as they deal with casualties instead of putting up a proper fence to stop people falling off the cliff in the first place.

Healthy Ireland is about prevention. Under it, we have published Tobacco Free Ireland, our strategy for making Ireland tobacco-free by 2025, by which we mean a prevalence of smoking of under 5%. In 2014 we are progressing legislation on plain packaging for tobacco products, smoking in cars with children present and licensing the sale of tobacco products. These are immediate initiatives that will have long-term benefits for the people, health services and, most important of all, our children. I thank the Acting Chairman, Deputy Jerry Buttimer, for his conduct of the Oireachtas Joint Committee on Health and Children in dealing with these matters.

I sought and received Government approval for a package of measures to tackle the misuse of alcohol through a public health Bill. We want to bring our average annual alcohol consumption figures down and combat the ill-effects of the misuse of alcohol not just for the health service but also the economy and, most importantly, society.

Healthy Ireland is a framework through which we want to tackle obesity, in particular childhood obesity. I am sure everyone in the House agrees that our future lies with the next generation and that we need a sustainable strategy to protect them from the wide-ranging negative health effects of childhood obesity. We will be focusing on this issue in 2014. I am very pleased that, as I say these words, the Minister for Children and Youth Affairs, Deputy Frances Fitzgerald, who is equally committed to this task is sitting beside me.

If Healthy Ireland seeks to address future health issues in the population, Future Health, our strategy for reforming the health service, seeks to put in place the building blocks for a 21st century health service - a single tier health service where care will be available on the basis of need, not income, through universal health insurance and with equity at its core. Since its publication in November 2012, we have made significant progress. We have established hospital groups and appointed a chairperson for each group. We are recruiting chief executive officers for them. Throughout 2014 work will continue to fully establish them on an administrative basis. The creation of hospital groups is a critical step in improving hospital performance and, ultimately, patient outcomes. In the short term the groups will harvest the benefits of increased independence and move away from the traditional command and control style of the HSE.

In July 2013 we established the directorate of the health service under the Health Service Executive Governance Act which also abolished the HSE board. We are bringing the HSE Vote back to the Department through the Health Service Executive (Financial Matters) Bill which is going through the House. A finance reform board is in place and a chief financial officer has been appointed in the HSE. A new financial and cost management system has been identified and is being costed. Throughout 2014 we will progress the legislation and continue to work on the management system. This will enhance accountability, as well as establishing a sustainable system for controlling costs which is essential in the current and future fiscal environment.

In 2013 we published the phase 1 report of the chair of the consultative forum on health insurance. The chair is proceeding with phase 2 and will report back to me very soon. As the House knows, we must continue to address issues in the private health insurance market as a basis for the introduction of universal health insurance. I am determined that the cost of private health insurance will be reduced. Astonishingly, there has been no clinical audit of the insurance system prior to this. There was no one to challenge doctors on why they were doing certain tests and the value of doing these tests. We have had a pretty loose audit of hospitals in the past, but that has changed. I am happy to say VHI has a cost containment programme and put in place measures which have resulted in one private hospital having to repay €5 million. I am sure there will be more. Equally, we must benchmark what we are paying consultants and why we are paying the money we are paying. The House will have heard me say often that we are still paying the same rate for procedures which used to take two hours but which now take only 20 minutes with modern technology. This has to stop.

Another key element of Future Health is the concept of the "money follows the patient". The introduction of the new funding system on a phased basis lays the foundations for universal health insurance. Following a pilot study in 2013, it is being introduced across the health service in 2014. It will provide the funding framework for improved and enhanced outcomes for patients, as well as the professionals who serve them. Put simply, if there is no patient, there will be no payment; therefore, the patient will be king or queen.

Despite the challenging financial circumstances, as part of budget 2014, we will introduce free GP care for children aged five years and under. Work is well advanced on drafting the required legislation and the development of an associated GP contract to ensure this service will commence this year. We will continue work on the development of options for the provision of a GP service without fees for the entire population. I say to those who query the wisdom of providing this service when we have other issues with which to deal that we really need to drive home the message that primary care and general practice is where most medical needs can be met. It is also more cost effective and convenient for patients. That is the direction in which we must move as we cannot continue with the hospital-centred approach as it would break the economy, even if we did not face the fiscal challenges we currently face. As I said, the Government is committed to a major enhancement of primary care services as part of the move towards universal health insurance. This step towards a phased introduction of free GP care must be seen in that context.

In December 2013 we published the Health Identifier Bill and launched our e-health strategy. Technology can enhance health care, improve outcomes and drive efficiency. To implement it, e-health Ireland will be established initially in the HSE. It will be headed by a chief information officer for the health service who will be recruited through an open competition. Priority areas for initial development include e-prescribing, online referrals and scheduling, telehealth and the development of summary patient records. Again, on a day-to-day basis, the judicious use of technology brings greater efficiencies, but in the long term the use of technology gives us more information and, therefore, enables us to make better health care decisions. Ultimately, it saves lives and money.

I would like to make the point Dr. Susan O'Reilly, director of the National Cancer Control Programme, has often made that better organisation and management can yield a 10% improvement in outcomes for patients. If there was any doubt about this, last week I launched Lollipop Day for the oesophageal cancer support group and while none of the treatments has changed, the organisation and delivery have and the outcomes for those with oesophageal cancer have improved by 20%. That shows how organisation and management are such a critical part of improving outcomes for patients; it is not just about medical care.

Health service staff are of high quality and dedicated individuals who need and deserve high quality and dedicated facilities. Despite the significant challenges we face, since 2011 the Government has progressed 34 primary care centres and a further 12 have been approved for building. As resources permit, the network will be expanded. We are also developing the national children's hospital, with the aim of starting to build next year. We are relocating the National Maternity Hospital, Holles Street, to the campus of St. Vincent's University Hospital at Elm Park. A project team has been appointed and we expect a design team to be appointed shortly.

We are also developing a new central mental hospital in Portrane for the care of those with mental health issues and work on that project is well advanced.

As well as looking to the future, we have sought to address legacy issues. In particular, the State Claims Agency is implementing a redress scheme for women who had been excluded from the 2007 Lourdes Hospital redress scheme on age grounds alone. I commissioned a research report on symphysiotomy and appointed Judge Murphy as mediator. When she reports, I will consider that report and bring proposals to the Government for approval. We cannot move forward on the issues of tomorrow without having resolved the issues of the past.

The House will be aware of the significance attached to the plan by this Government to introduce universal health insurance. Universal health insurance is fundamental to the reform of our health services and goes to the core of Future Health. It has garnered significant media attention in past weeks and while universal health insurance is undoubtedly the final destination for health care reform, the White Paper represents the beginning of the journey. The Government and I are at one in agreeing that we need the input of the Irish people. The health services serve the people and they have the right to interrogate rigorously this Government's vision of the future of those health services. We will put a comprehensive plan for consultation in place so we can have a national conversation on the future of our health services. The Acting Chairman, Deputy Buttimer, will find himself at the centre of that conversation in his role as Chairman of the Oireachtas Joint Committee on Health and Children. I wish him well in his work and know he will allow a full and frank discussion and debate involving all who are interested in this issue. This principle is key, not just to the consultation but to universal health insurance itself. If universal health insurance is about one thing, it is about fairness. A fair system is one where everyone pays according to his or her means, where the basket of health services is decided on transparently and openly and where good performance is nurtured and encouraged and bad performance is addressed and improved. This is the health service we envisage under universal health insurance.

All of the various reforms I have outlined, including the money follows the patient principle, hospital groups and eHealth, are designed as building blocks for universal health insurance and for a health service that is pragmatic, practical and rational. We want a health service that is open and transparent and one that can deal with future challenges. That is where we are going and I look forward to working in partnership with stakeholders and the health services in achieving this goal, always with the clear purpose of improving outcomes for patients.

I welcome the opportunity to take part in this debate. This is an important opportunity for this House to take stock, for the Government to outline the actions it has taken and to discuss the challenges that remain. We must all continue to work to improve the lot of Irish citizens. While I understand the role of the Opposition, it is disappointing that a number of Deputies have come into the House and made not one reference to the Government's achievements. They did not refer, for example, to the change in the job situation where, instead of losing 7,000 per month, 5,000 jobs are being created. They made no reference whatsoever to the changes in the public finances, in Ireland's international reputation or to what we are being charged in interest when we borrow. They made no reference to the various reforms that are taking place, not least in the areas of health, local government and social welfare. No mention was made of the focus on activation in the Department of Social Protection which means that people are no longer passive recipients of money but are given the opportunity to participate in training and education programmes. This Government has taken action on many fronts. There is no doubt that many challenges remain, but at least when Deputy Mary Lou McDonald addressed the House, she commented on the legacy issues which this Government had to face when it took office.

I will focus this morning on my own area and the initiatives that I have taken in driving forward the range of Government commitments as they relate to children and families. We are in the midst of an ambitious reform agenda because our aim for children and families is to change fundamentally how services are delivered to them. We are working to integrate those services, to allow those services to respond earlier and to allow for joined-up thinking and a degree of independence not previously afforded in the context of service delivery. I will take this opportunity to comment on some of the initiatives I have taken and to lay out the challenges that remain. I am certainly not complacent and do not think that reform in the areas I have mentioned can happen overnight. What is important is to be on the right pathway to achieving the goals which the Government has set out and which I, as Minister, have set out for my own area.

I have delivered on a number of key programme for Government commitments, including holding the children's referendum, establishing the dedicated new Child and Family Agency and securing funding for and commencing work on new national child detention facilities. The latter is important because it takes all 16 and 17 year olds out of the prison service. We are now beginning to have a debate about what happens to those under 25 in our prison service but certainly taking 16 and 17 year olds out of the prison system is extremely important and has been advocated for more than 50 years. This Government has delivered on that commitment at a time of unprecedented financial difficulty. We have put our money into ensuring that 16 and 17 year olds will not be in prison facilities, thereby increasing the chances that those young people will not continue in a life of crime but will get a second chance. This is an extremely important initiative and in a time of extreme financial difficulty, we decided that it was a priority to try to interrupt that cycle of crime for young people and to give them a real opportunity for a second chance.

The free pre-school year is an extremely important initiative introduced by the previous Government. It was very difficult to sustain that service at a time of such economic difficulty but we have done so and have provided an additional €15 million to deal with population increases. The free pre-school year is extremely important and I am delighted that we have been able to maintain it. Huge concerns have been expressed about the quality standards in our early years services and that is certainly a problem. Previous governments have focused too much on bricks and mortar and did not invest in training and supporting front-line workers and ensuring that they are qualified for their roles. That is what this Government is focusing on to ensure the quality of our early years services because that is what parents want. We saw what was exposed on the "Prime Time" programme recently, which is a legacy of many years. The situation will not be turned around overnight but I am determined that we will introduce quality standards, training and inspections because that combination will make a difference so that parents can trust in the services they are using. The Government is also investing €30 million, with support from philanthropy, in area-based childhood programmes in 12 areas around the country where children are most in need. We have also completed a promised review of the implementation of the youth homelessness strategy.

There is much more that needs to be done and I will highlight, briefly, my priorities for the coming year. I will be publishing the Children First Bill shortly - it is going to Cabinet in the coming weeks. We will complete the development of the child detention facilities. I want to support and develop the work of the recently established Child and Family Agency, one of the biggest public-sector reforms in which this Government has been involved. I will be amending the Child Care Act in respect of after care. I recently secured Government agreement that social workers would carry out an assessment of the need for after care for those children in the care of the State at the moment, who number 6,200. I will launch Ireland's first ever early years strategy and a policy on family supports and parenting.

We know parenting is a complex task and we want to see what the State can do to support it.

I will continue quality improvements in early years and child care services. I will enhance the preservation, management and access to adoption records. This has been on the agenda since 1999. I will bring forward legislation to improve access to those records and ensure they are managed properly. So far, they have been dispersed across the country. I will bring in legislation to ensure that those who hold records have a statutory obligation to declare they have them. We will bring those records together, preserve and manage them and improve access to them.

My Department is finalising the Children First Bill which will place elements of the Children First national guidance on a statutory basis. This was first promised in 1999 and promised again under the Ryan implementation report in 2009 but not delivered. That will be delivered this year.

This year the priorities of the Child and Family Agency will include recruiting additional social workers in line with the additional budget allocations in budget 2014; rolling out new models for dealing with child abuse and neglect cases, of which there were 42,000 last year, with better liaison with the voluntary sector; commencing a three-year plan to double the number of special care places; and delivering greater efficiencies and savings in legal costs. What is happening in this area is not sustainable. There will be a national approach to legal costs and the guardian ad litem system will be reformed. We will also introduce 24-hour access social work services.

In the past few days, I approved this year's business plan for the Child and Family Agency. The heads of the aftercare amendment Bill were submitted to the Cabinet last week and will be referred to the Oireachtas Joint Committee on Health and Children on 11 March. This is another example of implementation of a policy that has been called for by many groups who care about young people.

I welcome the opportunity to update the House on my plans and challenges for the year ahead. I want to build on the momentum achieved and to deliver on our commitments. There are significant challenges but I am committed to rising to them, delivering valued improvements to services for children and families. Many of these initiatives have got support from all sides of the House. I welcome that support and the constructive discussions we have had on many of them. I wish the debate in this House was as constructive as some of the support I have got for the initiatives I brought forward. It is extremely important for the people that when we are debating in this House we recognise the initiatives that have been taken that make a difference in the jobs arena and other areas, as well as the challenges that remain.

I call on Deputy Nulty who is sharing time with Deputies Grealish and Naughten. Is that agreed? Agreed.

I commend the Minister for Children and Youth Affairs for introducing the aftercare amendment Bill in which she has had a long-term interest. As other Deputies have said, the ordering of business in the Dáil this week is shambolic with set-piece speeches to be delivered. It is a farce given the serious crisis issues facing many people in our community to allow this type of debate to take place.

I am disappointed the Minister for Health, Deputy Reilly, ran out of the Chamber just now because I wanted to tell him what is actually happening in our health service. His speech would not have been out of place in a George Orwell novel because it had no root in reality. If one talks to those working on the front line in the health services, from community services to acute hospitals, they will all say the health service is in crisis. For example, Connolly Hospital, Blanchardstown, in my constituency has a massive catchment area. I speak to staff in that hospital every week. Last week, I spoke to several front-line workers there who told me about the low levels of morale and all-time high levels of stress and fear for the future for the health services among health staff. Experienced workers in the health service told me unreasonable demands were being made of reasonable people who are concerned for their patients.

The one element not driving the Government’s health policy is an absolute commitment to the right to health care and to patients’ interests. I have spoken to very ill patients who were left sitting on chairs in Connolly Hospital accident and emergency unit for eight hours. Staff were run off their feet with chaos at the department. This is a direct result of the Government’s policy on recruitment embargoes while hiring agency workers rather than employing nurses full time. This, in turn, prevents opening up beds to alleviate capacity in acute hospitals.

I know of very ill people on serious and costly medication who have had medical cards for over ten years but now the Health Service Executive has decided they do not qualify for the card. That is another direct result of the Government’s policy. Its strategy is to outline its reduction in expenditure in health, social protection and housing but pass it off to bureaucracies to implement. That allows Government backbenchers to blame the HSE, claiming it is a technical issue when, in fact, there is massive pressure put on these agencies to slash expenditure. Health is a demand-led service due to medical need but the Government’s policy is governed by driving down costs, coupled with a lack of co-ordination in how we deliver health services.

The crisis in our housing system was raised this morning with the Minister for Social Protection. Her response was derisory and insulting to those on housing waiting lists. The reality is that we have 100,000 families on housing waiting lists and a massive building programme is required to address this. Not only would that create jobs and reduce social protection expenditure, it would also deal with the crisis. I am aware of numerous examples of families who do not know if they will have a roof over their heads next month. This matter was raised with the Taoiseach yesterday on Leaders’ Questions. What did he say in reply? “Sure, God love them”. That was his response to a housing crisis because he is not knowledgeable and is ill-informed about what is actually happening to our citizens. We are not talking about long-term homeless people with addiction issues and so forth. We are talking about numerous families who cannot meet the rents demanded by landlords.

One obvious solution is that instead of paying rent supplement, the Government develops a scheme to acquire houses from landlords on a long-term basis while using the rent supplement scheme as a mortgage payment.

Not only would this increase the social housing stock and represent the acquisition of assets for the State, it would also help the housing waiting lists. That is one solution the Government has refused to consider. A stimulus plan for housing is another solution. The changes announced in the recent budget do not even reach the tip of the iceberg with regard to this crisis. Will the Government explain to families sitting at home watching this debate and wondering how they will provide a roof over the heads of their children what it expects them to do?