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Dáil Éireann díospóireacht -
Wednesday, 4 Jun 2014

Vol. 843 No. 1

Leaders' Questions

Before I start, may I compliment the Minister, Deputy Noonan, on the manner in which he dealt with his recent surgery and to wish him every best wish in the time ahead? It has been a good week for Limerick, what with the hurling and the Minister's own good performance-----

-----and so we await a good summer and well done to the Minister in this regard.

I put into the Minister that Ireland is in the midst of a crisis in the health insurance market. It is undoubtedly experiencing a downward death spiral and an approximate average of 4,000 customers left the market each month in the year up to March 2014. Moreover, 21,000 people have left since the beginning of this year alone, that is, approximately 1,600 per week have quit during the first three months of this year. There has been a haemorrhaging of young and healthy customers from the market, which threatens the very sustainability of the health insurance market into the future, leading to much higher premiums for those who remain in the health insurance market, as well as creating huge pressures for the public health system as Members are aware and as is being experienced.

In response to this, Government policy is incoherent. Insured patients are now subject to dramatically increased charges for public hospital beds - up to approximately €852 per night - which constitutes a dramatic increase. If one adds to this the significant curtailment of tax relief that was announced in this year's budget, overall one gets a Government charge of approximately €300 million. The Government has dipped into the pockets of private health insured people to the tune of approximately €300 million in recent times. All of this has had a dramatic impact and has accelerated further the exodus from the health insurance market itself. Meanwhile, the Minister, Deputy Reilly, peddles the mandatory universal health model, which is vague and uncosted. Incidentally, I note the Taoiseach failed to voice confidence in the Minister for Health yesterday, having been asked to so do.

Does the Government accept there is a crisis in the health insurance market? Has it proposals to help to resolve the crisis?

The backbenchers want to get rid of the Whip as well.

Hold on a second, you are not Minister yet.

They want to see the back of him too. He is on the hit list.

There will be a shake-up over there, a Cheann Comhairle.

First, I thank Deputy Martin for his good wishes, which I very much appreciate.

From the point of view of the Minister for Health, his clear objective is to reform the current health system and to deliver a single-tier health service in which access to health care is based on need and not on the ability to pay. The Government is committed to the ongoing sustainability of the health insurance market as part of the transition to a market-based universal health insurance system. At the end of March 2014, some 2.3031 million people were insured with inpatient health insurance plans. While the number of people covered has fallen from a peak in 2008, Ireland continues to retain a high level of population holding voluntary private health insurance at 44.2%. The Minister for Health desires the best possible environment within which more people, particularly young people, will wish to obtain and retain private health insurance cover that is affordable, competitive and meets consumer needs.

He intends to introduce shortly a series of measures to help to support the sustainability and competitiveness of the private health insurance market. This includes lifetime community rating to encourage people to join health insurance schemes at a young age and to retain their private health insurance cover. In addition, the Minister will announce shortly an initiative on mandatory discounts for young adults. The Government is committed to keeping affordable health insurance for as many people as possible. To this end, the Minister has made clear to the health insurers his belief that significant savings from within the industry can still be made, the effect of which can be to minimise the need for increases in premiums. The recently-published McLoughlin interim report on health insurance costs made recommendations in a number of different areas, including the important role of clinical audit in identifying unnecessary claims. Moreover, the need to address the age structure of the private health insurance market is also important. As I already mentioned, the Minister, Deputy Reilly, will provide further details on his plans in this regard shortly.

I put it to the Minister that the market is no longer affordable for many people, particularly younger people, who are leaving the system in their droves. The situation was already critical enough but the Government added to the crisis by the measures it took in the budget. I do not simply refer to the restriction of tax relief but also to the increase in the cost and price of a public bed in a public hospital. This concerns people who were also paying their taxes but the bottom line is there is no confidence that the Minister has the capacity to sort this out. There is no confidence among Government backbenchers in the Minister or in his capacity to resolve this crisis. Indeed, members of the Labour Party have been saying openly for quite some time, over the past year and a half, that they did not think he was up to it. Although they did nothing about it-----

-----they said that and let everyone know about it.

A question, please.

Apparently, the five-a-side group is back and it is playing its game of five-a-side very actively at present.

They came out of their coma.

However, most critical of all, the Taoiseach did not say he had confidence in the Minister. He refused to say he had confidence or no confidence in him-----

A question, please.

-----which is kind of ominous. Will the Minister be around to implement these changes?

The Deputy knows he will not.

Moreover, I do not believe these changes will be adequate to deal with this crisis because the fundamental objectives of Government health policy are not meeting. On the one hand, the Government seeks universal mandatory health insurance but, on the other, it is implementing policies that are driving people out of the market, such is the incoherence of the policy approach. Very few people on the Government side appear to have confidence in the Minister's capacity to resolve this. I do not know why the Government should believe that anybody else outside of Government or the realm of Government backbenchers should have some confidence.

First, the economic policies pursued by the Government in which Deputy Martin participated from 2007 until 2011-----

Change the record. It is broken.

-----resulted in the loss of hundreds of thousands of jobs. When hundreds of thousands of people lose their jobs, they look at their expenditure patterns and one thing they inevitably give up is voluntary health insurance. The unemployed, as a result of the crisis Deputy Martin's Government caused, were the people who gave up health insurance. This happened in two ways, namely, through individuals making voluntary decisions and through people no longer at work losing out in the group schemes for health insurance that they enjoyed at work.

These are working people who have given up.

There are 70,000 at work in Canada.

There is nothing mysterious about this. In times of recession, when people lose their jobs, they cannot afford what they could afford when at work. Consequently, rather than trying to blame the current Minister, Deputy Martin should take some responsibility himself for the devastation he visited on hundreds of thousands of families in Ireland.

Change the record.

The Government was warned about this in January.

As for the second issue on the ability of the Minister for Health to deal with the issue, I have outlined what he intends to do and, by any standards, what I have outlined is a serious programme of reform that addresses the issues. More than 44% of people in this country still have voluntary health insurance for which they pay.

If one looks at the numbers over the years, this is quite high. Looking at the numbers back to the late 1990s, for example, it is below the peak of 2008 but practically everything in this country is below the artificial peak of 2008 when the boom and bust economy finally burst.

Including the Fine Gael vote.

He is a walking disaster.

Could you just stay quiet for a few minutes, please?

It was lucky he was around the night you needed him.

Ar dtús, ba mhaith liom a rá leis an Aire go bhfuil mé an-sásta go bhfuil cuma maith air. Tá súil agam go dtiocfaidh biseach air agus guím beatha agus sláinte air. Tá sé an-mhaith as a bheith anseo ag obair agus ag glacadh ceisteanna. Táimid buíoch dó agus tá súil agam go mbeidh beatha agus sláinte aige.

Last week in the Seanad the Minister for Health, Deputy James Reilly, stated that an issue had arisen concerning the commissioning of a report on maternity services in the west and in the north west. This report was carried out by a private consultancy firm called The Health Partnership, also known as DNF Health Partnership, a company with a long record of promoting privatisation of health services. There are very great concerns in the west and in the north west that this report, if implemented, could result in the closure of maternity services in that region. Is the Minister aware that the founder and 50% shareholder of this private consultancy firm was appointed by the Minister for Health, Deputy James Reilly, as chairperson of the west-north west hospitals group, a major State public health body? Does the Minister accept that this is a significant conflict of interest? Surely it is not appropriate that a major player in a private health consultancy firm that promotes privatisation of health services is appointed as the chair of a major public health body.

The Minister for Health has admitted that the commissioning of the report by this health partnership was not in accordance with HSE national financial regulations. Will the Minister for Health be called fully to account for making this appointment? Will the chair of the west-north west hospitals group be asked to stand down?

Ba mhaith liom mo bhuíochas a ghabháil leis an Teachta as ucht an méid adúirt sé faoi mo chás féin agus as na dea ghuíonna a chuireann sé chugam.

On the issue raised by the Deputy, this is a rather small country and people have different roles to play at different times in their careers and sometimes there can be an appearance of conflict. As I understand, no conflict occurred in this case but I do not have an extensive brief on it so the best I can offer the Deputy is to get back to him on the issue in due course when I request a further brief from the Department of Health.

I am very disappointed with the Minister's answer. How can he decide that no conflict occurred in this case when he has said that he has not been briefed on this matter? These revelations are very serious and they expose once again, in my opinion, the unsuitability of the Minister for Health and also they expose the Government's gross mismanagement of the public health service. It does not matter what is the size of the State. We have just witnessed the shameful removal of discretionary medical cards from citizens who need them - one shameful act following another shameful act. I ask for the Minister's opinion on whether the report into the reconfiguration of maternity services in the west and the north west can be relied upon as an independent and fully accountable report, given that it was brought about by this private consultancy firm which promotes the privatisation of health services. Perhaps he could tell me whether the Government will ask for this report to be withdrawn immediately. Does he agree that the chairperson of this west-north west hospitals group should review his position? Should the Minister for Health consider his position? What is the nature of the relationship between the Minister for Health and the chairperson of the west-north west hospitals group? After all, the Minister for Health appointed this person. Does the Government retain confidence in the Minister for Health?

As I said I regret very much that I am not briefed on this particular issue. However, I will draw the Deputy's questions to the attention of the Minister for Health. I will ask him to answer the Deputy directly and possibly to answer them in the House subsequently.

I thank the Minister.

I hope the Minister has had the opportunity since last week to familiarise himself a little more with some of the issues behind the Aer Lingus cabin crew dispute. I am hoping that the Minister may have had a chance to send someone along to the picket lines at Shannon to talk to the workers there and to understand why, for the first time in many years, over 1,000 workers believed they had no alternative but to engage in industrial action last week, an action which saw the virtual grounding of the Aer Lingus fleet with 200 flights cancelled.

I put it to the Minister last week in the House that how he would deal with this dispute would be one of the first measures of the post-election tests of this Government to determine whether it had listened to people. I do not think he has done a great job of it. Last week the company initially announced it would meet the workers, the first time after refusing to do so for three years, but no date was set and the strike went ahead. Last night insult was added to injury when on the eve of the so-called bilateral talks supposedly to resolve the issues, letters were sent to workers' homes intimidating them and withdrawing their staff privileges. This is hardly the antics of a company that wanted to resolve anything. It is like a husband agreeing to go to relationship counselling and then kicking his wife around the kitchen the night before. It is outrageous, bully-boy tactics by management and the Minister has stood by in silence and done nothing about it. In my opinion, lack of action condones such antics.

These actions by management were outrageous, particularly in the context of the weekend's goading and clamouring for such action by Michael O'Leary, the poster boy of anti-trade unionism-----

A question, please, Deputy.

-----who made his mark cheerleading a race to the bottom. Does the Minister wish his Government to be synonymous with this type of employment, the type of employment in Ryanair where nobody is directly employed, people are hired and fired at will, with no promotions, no pensions and no progression because nobody stays long enough? The Minister and the staff are the biggest shareholders in Aer Lingus. Sitting on the fence is not good enough any longer. What is he going to do to preserve workers' legitimate and laudable expectation to be able to do their work in a manner which respects their work-life balance?

It is a difficult industrial dispute and I do not think it helps that Deputy Daly intervenes in a partial manner on one side of the dispute and then uses the opportunity of the dispute to launch a proxy attack on Ryanair which is not a party to this dispute. The action taken by the workers on this occasion was disproportionate. I defend the rights of workers to take industrial action but I think it was disproportionate at the bank holiday weekend to discommode 30,000 ordinary people who had plans to have a break at the weekend by flying out of the country. The action was disproportionate. I said that to the Deputy last week and I repeat it this week. I also said that the way forward is to use the industrial relations machinery of the State, if it can be helpful to bring the two sides together. This dispute should be resolved, as industrial disputes are resolved, by talking and by compromise and by coming to a solution. I do not think it achieves anything to have a tirade against one side when there are two sides to every industrial dispute. At the end of the day, management and the representatives of the workers will have to sit down and resolve this dispute and they should do so sooner rather than later without discommoding the Irish public further.

I note the Minister did not take the opportunity of the intervening week to read up on the issues at stake. Ryanair has the biggest shareholding in Aer Lingus. If the Minister had read any of the newspapers at the weekend he would have seen that Michael O'Leary spent his weekend goading and cajoling Aer Lingus management to take precisely the action they took.

This is Leaders' Questions and the Deputy must put questions. She cannot launch into a tirade about X, Y or Z.

I am responding to the point the Minister made.

She must remember that this is Leaders' Questions.

The Government is a large shareholder in Aer Lingus. The combined shares held by Aer Lingus staff and the Government account for a majority shareholding in the company. As such, the Government is not an idle bystander in the current dispute. In stating that it would be useful for the parties involved to use the industrial relations machinery of the State, the Minister did not pass comment on the consistent refusal of management to do so.

I will put to the Minister two issues that have been put to me by workers. The first is from a cabin crew member, Una, a woman with 16 years' service who addresses the Minister's point about the dispute. She states that she is proud to be standing up for what she knows is right and that she needs her job and therefore needs conditions to be sustainable. She states the company makes staff feel like it does not want them but this, she adds, is hard to explain in an e-mail. She also states that staff are nervous about the action and do not want to ruin people's holidays. It is heartbreaking for everybody, she adds, but having been told to stand up to bullies, that is what staff must do. The Government is not on the sidelines in this dispute, which is difficult for the workers involved.

The Deputy is over time. She should ask a question.

As the major shareholder in Aer Lingus, does the Government believe it is acceptable for people to be bullied and driven out of a career on the basis that they cannot have a family life, as is afforded to pilots and every other cabin crew member? Is it unreasonable for people to ask to work in a more family friendly way? If that is not an unreasonable request, what is the Minister doing about it?

I am very sorry for anybody who is out of work through an industrial dispute or for other reasons. However, I am also very sorry for 40,000 ordinary Irish people who had planned an inexpensive holiday abroad in early June and were prevented from travelling by an industrial dispute which was, on the face of it, disproportionate given that there is industrial machinery in place that could assist in resolving this dispute. That is my position. I appeal again to both sides to talk out their differences and come to a satisfactory resolution.

Many people take holidays in June because their children are not doing examinations. While the families of children who are doing examinations cannot travel, other children in secondary school are on holidays in June when it is less expensive to travel than it is in July or August. Many of them take the opportunity to do so.

Individual cases are always sad and I am not criticising the Deputy for raising an individual case. However, there are 30,000 other individual cases involving people who were not able to take what was probably a well deserved holiday as a result of the industrial dispute.

They travelled on the day before the dispute.

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