Dáil Éireann díospóireacht -
Thursday, 3 Apr 2014

Vol. 836 No. 5

Leaders' Questions

Deputy Michael McGrath

On entering office in 2011, the centrepiece of the Government's health policy was the introduction of universal health insurance. It has taken three years for the Government to publish a White Paper on the matter, which it did yesterday. Unfortunately, however, that White Paper has given rise to more questions than it has answers in respect of universal health insurance. It does not, for example, indicate what will be the cost of universal health insurance for individual families and the State or what health services will be covered. Neither does it outline the income threshold that will determine whether someone will pay his or her own health insurance or whether the State will pay it for him or her. It is becoming increasingly clear that universal health insurance is going to be another tax on middle Ireland. It will be a further tax on working families which have already been put to the pin of their collar to get by financially. In essence, it will be a tax on the people who already pay for everything in this country.

Reading between the lines of what is contained in the White Paper and parsing what the Minister for Health, Deputy Reilly, said yesterday, it seems quite clear that the current tax relief on health insurance policies from which people benefit is going to be cut and will probably be phased out altogether by the Government. When one considers that this will be in addition to the complete abolition of mortgage interest relief by 2017, it is clear middle income families are looking at a double whammy of tax hikes. The elimination of tax relief on health insurance policies and the abolition of mortgage interest relief will give rise to an increase of approximately €700 million in the amount of tax paid by middle income families during the next five years.

The Minister for Health has stated that no one will be obliged to pay anything extra under the new system of universal health insurance. There is no basis whatsoever for that assertion, which has been contradicted by the assessment carried out by the Department run by his colleague in government, the Minister for Public Expenditure and Reform, Deputy Howlin, in respect of universal health insurance. When will families be presented with a clear picture of what universal health insurance is going to cost them and when will we be made aware of what will be the exact role played by health insurers in the context of their control of the health service in the future?

Minister for Education and Skills (Deputy Ruairí Quinn)

I thank the Deputy for his questions, some of which I will be happy to try to answer. I will not be able to answer all of them because the overall position will not become clear until the consultation process has been completed.

Labour was the first political party in Ireland to propose universal health insurance - based on multiple insurers - as long ago as 2001. At that stage, the Deputy's party ridiculed the concept in its entirety. Our spur then - as now - was the inequity and inefficiency of Ireland's two-tier health system. The Labour and Fine Gael parties believe that a person's access to medical care should be determined by his or her medical needs, not the money in his or her pocket. Quite frankly, that is the difference between the Deputy's party and the current Government.

Deputy Michael McGrath

Not true.

Deputy Ruairí Quinn

Fianna Fáil was in government for a long period and it was vehemently opposed to the idea of universal health insurance.

Deputy Michael McGrath

We still oppose it.

Deputy Ruairí Quinn

Which means Fianna Fáil supports the two-tier system.

Deputy Michael McGrath

No, it does not.

Deputy Ruairí Quinn

Yes, it does. The unfair two-tier system that has determined the course - and many of the problems - of our health service for many years is simply not working. It does not work for people who cannot afford private health insurance or who find themselves at the back of the queue for consultants' appointments. It does not even work for those hard-pressed families which struggle to pay for private health insurance, only to find - as every Member of this House who pays into the group scheme knows - that their premiums are increasing each year while their benefits are going down.

When the Labour Party first proposed universal health insurance as a means of reforming both access to the health services, and how those services are funded, public health spending stood at €7.2 billion. Six years later, in 2007, it had grown by €6.5 billion. It is, therefore, the most expensive in our entire domestic budget. As the Deputy is aware, reform is never easy and it has been made harder by the fiscal crisis which we have all been obliged to endure and which continues. The boom demonstrated that one can keep investing money in a broken system but that if one does not fix the root of the problem, very little will change. This is the first Government to face up to fixing the root of the problem and to agree to develop a universal, single-tier health service. It is also the first Government committed to a system that will guarantee access to care based on need, not income. Furthermore, it is the first Government to commit to universal general practitioner care because that will incentivise the delivery of care early and, therefore, more efficiently. In the coming weeks the Minister of State at the Department of Health, Deputy White, will bring forward the legislation necessary to allow for GP care, without fees, for those under six years of age.

The publication of the comprehensive White Paper on universal health care is an essential step in this direction. There are many questions which, by definition, cannot be answered in an optimum way until we have completed the consultation process. As a result, it is not possible to provide answers to the questions the Deputy posed with regard to what might be the cost of universal health insurance to different categories of people three or four years from now. There must be clarity. The purpose of publishing the White Paper is to facilitate an informed consultation process. People in this House and throughout the country are concerned about the quality of care available, on the one hand, and the crisis affecting the health service, on the other.

Deputy Michael McGrath

I fully support the idea of a universal health care system-----

Deputy Ruairí Quinn

I am glad to hear that.

Deputy Michael McGrath

-----in which access is based on clinical need. What I do not support is handing over the future of the Irish health service to private, for-profit health insurers, which is precisely what lies at the heart of the policy in this regard. I would have thought this is the complete opposite to what the Labour Party stands for. The fundamental question which arises relates to circumstances where a person will - under the proposed system - require access to the Irish health service. Who will determine the nature of and terms relating to that access? Will it be a doctor or will it be a private health insurance company? All the indications point to the fact that those in the private health insurance industry will make the decisions to which I refer.

There is another way to proceed, namely, by establishing a public health system fully funded from taxation. That is the alternative.

Deputy Peter Mathews

Hear, hear.

Deputy Michael McGrath

The bottom line is that policy in this area is going in completely the opposite direction to what the Government states it is trying to achieve, that is, encouraging increasing numbers of people to take out private health insurance and to ensure ultimately, through the roll-out of universal health insurance, that everyone will be obliged to have this. The Government is driving people out of the market. Thousands of individuals are dropping their health insurance as a result of the Government's policy and the decisions it is making. I refer in this regard to the change relating to the tax relief on health insurance premiums which was announced in the most recent budget. The Government is pulling in opposite directions in the context of its policy. People woke this morning to headlines in the Irish Examiner to the effect that they will-----

An Ceann Comhairle

We are on Leaders' Questions.

Deputy Michael McGrath

-----be obliged to pay €3,200 for health insurance cover for two adults and two children. That is the reality. Those who will be affected are people who currently cannot afford to pay for private health insurance. I am of the view that they deserve answers.

Deputy Ruairí Quinn

I think the Deputy will concede that the existing model is not working satisfactorily. While we may argue with regard to why this is the case and about the details involved, I do not believe anyone could say the current system, which is extremely expensive by international standards, is working properly. Whether it is because of his political ideology or his knowledge of the British national welfare system or the American system, he has immediately jumped in, without either reading the White Paper or clarifying the position-----

Deputy Michael McGrath

I have read the White Paper.

Deputy Ruairí Quinn

-----and made presumptions.

The Deputy has not clarified the situation for himself or established in fact that there is an option for a not-for-profit health insurance model. It was established by the coalition Government in 1954 and called the Voluntary Health Insurance Board. It is a not-for-profit health insurance system. Many of the systems in continental Europe which have a-----

Deputy Michael McGrath

It is a for-profit model.

An Ceann Comhairle

Sorry, there is a time limit here, please.

Deputy Ruairí Quinn

I am trying to answer the question Deputy McGrath put to me and he is not accepting it. We have a not-for-profit model insurance company already. Fully 40% of people already have voluntary health insurance. It is not an option to eradicate an insurance model and go back to the British national health system as if we had a clear landscape. We are looking for a system whereby there will be multiple choice within a not-for-profit insurance system to enable us to get the right kind of care and not the kind of high-cost insurance model that exists in the United States.

Deputy Mary Lou McDonald

Yesterday, the Minister for Education and Skills, his party and the Government voted full confidence in the Minister for Justice and Equality. It is clear that they all believe the Minister for Justice and Equality, Deputy Shatter, to be a reforming, progressive and just Minister despite the series of debacles over which he has presided. The issues around the administration of justice and An Garda Síochána have not gone away but that is not what I wish the Minister for Education and Skills to address.

I call on the Minister to explain how it is that this reforming Minister for Justice and Equality refuses to acknowledge the survivors of the Bethany Home, those who went through the mother-and-baby homes or those citizens of the State who were illegally adopted. Yesterday, the 222 infants and children who died of neglect at the Bethany Home were, for the first time, officially recognised and mourned at a sobering ceremony in the cemetery at Harold's Cross. The State failed in its duty of care to these children.

In opposition, the Minister's party, the Labour Party, and Fine Gael acknowledged this grave injustice and promised to address it. However, it took a determined campaign on the part of the Bethany survivors to end the appalling indignity of the burial of these children in an unmarked grave. The Minister, the Government and the reforming Minister for Justice and Equality have flatly and coldly refused the Bethany survivors the dignity of recognition, the justice of a State apology or the decency of access to a redress scheme. That is totally unacceptable.

When the Government assumed office amid a fanfare of promises of reform, transparency and a new way of doing politics it had an opportunity to end this injustice. However, this Government, like the last, has turned its back on the Bethany survivors. Will the Government now finally face up to its responsibility to these citizens? Will it make an official State apology to the survivors? Will the Minister ensure that they have access to a State redress scheme?

Deputy Ruairí Quinn

I, personally, along with everyone in this House who has the benefit of living in a more enlightened time than that of our grandparents, automatically and instinctively empathise and sympathise with the people who had the experience of being abandoned, for whatever reason, and placed into child care homes, which were cold places for any child who could have expected to be brought up in a loving environment. The State looked back on the record of our predecessors, our forebears in this Chamber and those responsible for placing, with the authority of the State, people into institutions which subsequently turned out to be places of extraordinarily abuse. We are all familiar with that. I have had some experience in this regard and I have to say that the Government has not been satisfied that in the case of the people who were placed in the Bethany Home and who had a very difficult and harsh experience, which no one can excuse, agents of the State were responsible for placing those people into those homes.

Deputy Seán Crowe

Governments said the same about the Magdalen laundries.

Deputy Ruairí Quinn

It is a matter of dispute. The principal stands, that is, if sufficient and satisfactory evidence, that is conclusive and in form similar to that of other institutions where a response has been made, can be convincingly brought forward, then the Government is of course prepared to look at it, but so far we have not been convinced.

Deputy Mary Lou McDonald

I do not accept as an excuse the fact that Ireland back in the day was a harsh and cold place, although that is absolutely true. As the Minister is aware, the Bethany Home was a maternity home, a children's home and a place of detention for women. The Minister knows, as I know, that the Bethany Home on Orwell Road in Rathgar, was subject to inspection under the Registration of Maternity Homes Act 1934. The Minister knows, as I know, that the State, under the Department with responsibility for local government as well as public health inspectors, has records cataloguing the deficiencies, defects and neglect in that home. There is a State record of the neglect and abuse. It exists and it is evident for the Minister. The Minister knows - he knew it on the Opposition benches as did all Members there - that the State failed these children.

It is not simply a matter of who placed the children in these homes. The issue is the failure of the State to oversee adequate and proper standards and to secure the safety of those citizens in that home.

An Ceann Comhairle

Thank you, Deputy. A question, please.

Deputy Mary Lou McDonald

The Minister knows this and the evidence is there; it has been presented to the Government. I call on the Minister in a spirit of justice for these survivors to quickly address the issue, to recognise their experience, having viewed the evidence, to acknowledge it, to apologise on behalf of the State for it and to allow them access to a redress scheme.

The Minister will also be aware of my final point. As it happens, the Bethany Home in Rathgar catered, for the most part, for children from the Protestant tradition. There is a deep hurt among survivors because they believe that they have been ignored by the State. This is doubly the case because they believe in some measure that they have been set aside because they came from a minority faith. It is essential that we do the right thing for these survivors, that we recognise their experience and put to rest any concern they may have that whatever about the old Ireland, in the new Ireland there is any form of discrimination against any citizen on the basis of religious beliefs.

Deputy Ruairí Quinn

I thank the Deputy for raising this matter. Along with most people in the House, if not everyone, we share many of the sentiments she has expressed. I am prepared to request that the Department of Justice and Equality would look again at the information to see if something analogous or comparable with that of victims of institutional residential abuse or the Magdalen laundries can provide the basis for some reaching out and redress. That is all I can say at this point.

Deputy Joan Collins

There are still many questions to answer in respect of the Minister for Justice and Equality, Deputy Shatter, the letters and the resignation or retirement of the former Garda Commissioner, Mr. Callinan. I take issue with the double standards of the Labour Party in government. Last night, Frank McBrearty and Sarah Bland were in the Visitors Gallery. These two individuals have raised serious questions about the justice and Garda system in this country. Their response, not mine, was that it was a mirror image of previous debates they have seen when the Labour Party and Fine Gael were on this side of the House and Fianna Fáil was on that side of the House. The silence of the Labour Party when the penalty points and whistleblower issues were being raised was woeful and the belated intervention of Labour Party Ministers after that of the Minister for Transport, Tourism and Sport, Deputy Varadkar, was glaring.

I take issue with what I see as the heart of what we are dealing with. There have been many instances of Garda malpractice, alleged malpractice and injustice in this country.

These include the high-profile and continuing case of Mr. Ian Bailey. When the Minister was on this side of the House, he railed about how badly the Fr. Niall Molly case was handled. The matter has been out in the public domain. Senior Fianna Fáil Ministers were at the scene and senior Fine Gael Ministers colluded with the church to-----

An Ceann Comhairle

I am sorry, but the Deputy cannot make allegations-----

Deputy Barry Cowen

That is desperate rubbish. It is unsubstantiated.

Deputy Joan Collins

It has been debated out in the open.

An Ceann Comhairle

It is not in order in the House to make allegations that one cannot substantiate.

(Interruptions).

Deputy Joan Collins

They colluded with the church to destroy the name of Fr. Niall Molloy.

Deputy Arthur Spring

Step outside the House.

Deputy Joan Collins

Ms Sarah Bland was sexually abused by her father even though her mother, Ms Patricia Bland, tried to raise the issue and get an interim custody order in 1981. This matter has been out in the open. It was debated at Stormont in 2001 and 2007 and in the Seanad in 2009.

Deputy Paul Kehoe

We cannot name people. That was a terrible accusation.

Deputy Joan Collins

Patricia and her daughter, Sarah, who came over from England last night to hear the debate, are taking a case and have provided detailed statements to the Garda in respect of allegations about perverting the course of justice, obstructing justice, deliberate collusion, suppression of the evidence of a witness in a court of law and-----

An Ceann Comhairle

Will the Deputy put her question, please?

Deputy Joan Collins

-----failing to report the crime of incest to the Garda. This case is being taken against the Minister for Justice and Equality, Deputy Shatter. We also had the Ms Cynthia Owen case-----

An Ceann Comhairle

I am sorry, but the Deputy is over time.

Deputy Joan Collins

This is important because it is at the heart of what we are doing.

An Ceann Comhairle

No, you are over time. Just put your question. These are not statements.

Deputy Joan Collins

There is a serious question over the Cynthia Owen case and the Minister has refused to meet her family. Will the Labour Party, within 48 hours, set up a commission of inquiry into these cases, the further 32 cases mentioned by the Taoiseach last Thursday and the racial profiling of Traveller children? These are serious issues and, unless they are dealt with, we will never move on.

An Ceann Comhairle

Before the Minister replies, I want to put it on record that this is not a court of law.

Deputies

Hear, hear.

An Ceann Comhairle

You cannot make statements that you cannot substantiate. We have an obligation to everyone to raise issues, but not to make allegations that we cannot substantiate. That is what the courts are for.

Deputy Paul Kehoe

Tell her to repeat it outside the House.

Deputy Ruairí Quinn

The only commission that we are committed to establishing arising from a Government decision in response to the revelations about the tape recordings in Garda stations across the country is the commission of investigation into those matters, headed up by the soon-to-be-retired Supreme Court judge, Mr. Justice Nial Fennelly. There is enough to be going on with in that particular matter in terms of correspondence on tapes and all of the other allegations about which we are all concerned, but about which none of us has the facts. It would be wise if this Parliament endorsed the establishment of that commission. The terms of reference are being discussed by the Government and will be discussed and finalised with Mr. Justice Nial Fennelly. They will then be brought to this Chamber so that we might debate what we want this person to inquire into and establish by way of fact. Against that, we can subsequently propose remedies, solutions, commentaries or whatever. I respectfully suggest to the Deputy that, when the draft terms of reference have been concluded by the Government and Mr. Justice Fennelly-----

Deputy Peter Mathews

And the votes.

Deputy Ruairí Quinn

-----they will be brought to this House and debated. It will be open to this House to add, subtract or amend in whatever way it so decides.

Deputy Róisín Shortall

The Minister knows it is a numbers game.

Deputy Peter Mathews

It is a numbers game.

Deputy Ruairí Quinn

It is called Parliament, Deputy.

Deputies

Hear, hear.

Deputy Peter Mathews

It used to be Parliament.

An Ceann Comhairle

Through the Chair, please.

Deputy Patrick O'Donovan

It is also called a democracy.

(Interruptions).

An Ceann Comhairle

Deputies, please.

Deputy Peter Mathews

I am sorry, a Cheann Comhairle.

Deputy Patrick O'Donovan

Where was Deputy Mathews last night? There was no sign of him.

Deputy Ruairí Quinn

I did not catch all of the details of the concerns expressed by Deputy Joan Collins, but it would be appropriate if she chose to attempt to have the terms of reference of that commission of investigation amended.

Deputy Paul Kehoe

Deputy Mathews did not have the courage to turn up last night.

Deputy Joan Collins

The facts about the issues I raised are undisputed. The family of Fr. Niall Molloy will not be happy to hear the Minister state that the Government has enough to go on with thanks to the tapes. The Taoiseach told the House that, as soon as he realised the gravity of the situation, he moved into action and a commission of investigation was set up within 48 hours.

Deputy Paul Kehoe

Fair play to him.

Deputy Joan Collins

These cases have been out there for years. Why is there not the same intensity of response to the cases of Fr. Niall Molloy, Cynthia Owen and Sarah Bland as well as the many other cases in which people cannot move on with their lives because they have a sense of injustice and feel that they have been caught in a warp? Why is the case of the Traveller family whose two and three year olds are on the PULSE system not being dealt with immediately? Why does the Minister not agree that these matters should be dealt with very quickly and that a commission of inquiry should be established? Is he afraid to take up these issues?

Deputy Ruairí Quinn

I appreciate the Deputy's concern for these matters. I am in no way doubting her sincerity. However, this is not the way to do business in an assembly like this. We have decided to establish a commission of inquiry into very serious allegations of a practice that has been going on for the past 30 years-----

Deputy Joan Collins

The Minister was talking about it for years while on this side of the House.

Deputy Ruairí Quinn

Just let me finish, please. That practice could have significant implications for a range of matters that we do not yet know, as we have not had a chance to find out what is on those tapes and what their consequences could be. I suggest respectfully to the Deputy and every other Member of the House that we establish that commission and debate it in the Chamber. The Executive will, with Mr. Justice Fennelly, agree a set of terms of reference that will be brought to the House for approval. If Members from all parties have concerns about the adequacy of those terms, let us agree to have them so amended if that is the will of this particular Chamber, and then-----

Deputy Peter Mathews

What about the Independents?

Deputy Patrick O'Donovan

Deputy Mathews never turned up last night.

Deputy Ruairí Quinn

-----we will proceed.

Deputy Peter Mathews

"All parties". Independents.

(Interruptions).

Deputy Ruairí Quinn

It would be irresponsible of me, on behalf of the Government, to give an instant response to Deputy Joan Collins to the effect that we would do that. There are ways-----

Deputy Joan Collins

These people have been waiting for years.

Deputy Ruairí Quinn

-----of doing business here.

Deputy John Halligan

When the Government was in opposition, it called for an investigation into some of these cases. What is the difference now?

An Ceann Comhairle

Please, this is Leaders' Questions. It is not a debate.

Deputy Róisín Shortall

There are supposed to be answers as well.

Deputy Paul Kehoe

Where was Deputy Mathews last night?

Deputy Peter Mathews

This is still the old way of doing business.

Deputy Patrick O'Donovan

Mario Draghi was on the telephone.

Deputy Paul Kehoe

Where was the Deputy last night?

Deputy Peter Mathews

Working effectively.

Deputy Patrick O'Donovan

He was afraid he might lose a number.

Deputy Paul Kehoe

The Deputy did not have the courage to turn up.

Deputy Peter Mathews

I have plenty of courage.