Leaders' Questions

In his political messages and speeches to the people and this Dáil, the truth simply does not matter to the Taoiseach. He will say anything to get elected. He will say anything to cover up something. He will deny reality and the truth when it stares him in the face. Language means nothing-----

We do not normally attack people by saying they have been telling untruths in the Chamber.

Language means nothing to the Taoiseach. He breaks promise after promise-----

Fourteen years.

-----believing that media management will take care of everything. Nowhere is this behaviour more manifest than in the Government's abandonment of universal health insurance, which was the cornerstone of its health philosophy for the past ten years and longer. The Taoiseach promised it in 2007 and in 2011. He said it would eliminate the number of people waiting on trolleys, reduce waiting times and provide equal access to all. Instead we have record numbers of people on trolleys, record waiting times and morale at an all time low in our health service.

The Taoiseach has been in denial for the past five years on this issue. In here he has kept on saying the Government would deliver universal health insurance. He even said that a time of economic crisis was the best time to deliver it. He was told repeatedly that it was unworkable by officials in the Department of Public Expenditure and Reform and the Department of Finance. He was told this in an independent study commissioned by Fianna Fáil and offered to him by Deputy Billy Kelleher. That study raised the very same concerns KPMG and the ESRI have now raised and which have resulted in the abandonment of this policy. The Irish Medical Organisation said it would go down in history as one of the greatest mis-sellings of health policy ever.

A question, please.

Where is the Minister?

The Taoiseach dismissed all of this. He rebuked all and sundry who questioned it. The IMO said it is one of the biggest cases of political mis-selling in recent history. My question to the Taoiseach is this. How did he get it so wrong and make such a mess of it? One senior Labour Party Minister said this was an astonishing mess. He said the Labour Party was for universal health insurance in principle - as the Labour Party is for everything in principle - but not this mess.

Another fine mess.

Why would anyone believe anything the Taoiseach says on health policy ever again?

Paddy needs to know.

Would Deputy McGrath please stay quiet?

I reject Deputy Martin's assertions. The Government remains committed to the ending of a two-tier health system which clearly has inadequacies and inefficiencies. The Government is still committed to the implementation of universal health care funded by a universal health insurance model.

The Government commissioned the ESRI to carry out a report on the costings in respect of the universal health insurance model put forward in its programme for Government. The Government has taken into account the findings of the ESRI report and will not implement the findings of the report in respect of this particular model given the costings and the levy which would be imposed on people.

While I could quibble with elements of the ESRI report in terms of margins, transaction costs or unmet needs costs, the fact of the matter is that far from ignoring the truth, reality and reports, the Government takes into account the findings of the ESRI report and I note that the author was very clear this morning when talking about this particular model of universal health insurance.

The Government and the Minister intend to continue on the path of reform which has been under way for a number of years. We will commission further work as envisaged by the ESRI in its report. Other models of funding should be, can be and will be examined. From Government's perspective, we want to continue to hold to the ending of the two-tier health system. We want to introduce universal access to health care based on medical need and we will continue to look at funding models which are different to this particular model examined by the ESRI. The ESRI produced its findings at the request of Government, which commissioned this report, following the publication of the universal health insurance White Paper published in 2014. That is slightly different from Fianna Fáil's programme for health, which was rejected by Deputy Martin's author.

George Washington once said it is better to offer no excuse than a bad one. I respectfully put to the Taoiseach that what I said at the outset is reflected again in his reply. Language means absolutely nothing to him. He will say anything. He has just now said he does not propose to implement the findings of the ESRI report. The ESRI report is an evaluation of the model that his Government and he approved in the White Paper 18 months ago. Does the Taoiseach get that?

Yes, but he said a lot then.

(Interruptions).

Deputy Martin never fails to amaze me.

The ESRI, KPMG and others have said what the Taoiseach was proposing in his model and said represented value for money would potentially cost a family with up to two children approximately €8,000 to €9,000 and would cost the State approximately €6.5 billion. Now the Taoiseach comes in here and says the Government is no longer doing "that" model. The Taoiseach spent ten years telling the people that he was going to implement that model-----

What has Deputy Martin's model done?

-----but he did no research. There was no blueprint, because it did not matter. The truth did not matter to the Taoiseach before the last election and it did not matter to him for the past five years.

Will Deputy Martin put his question, please?

The Taoiseach did not have a bull's notion how he was going to get there-----

(Interruptions).

Will Deputy Martin put his question?

-----and he still does not know, because he just talks about models.

(Interruptions).

Will the Deputy put his question?

I will indeed. I put it to the Taoiseach that the Labour Party Minister is correct that this is an astonishing mess.

Where is the Labour Party Minister?

(Interruptions).

The Minister said the Labour Party was for universal health insurance in principle but not this mess-----

Deputy Martin is over time. Will he put his question?

He said there are still large chunks missing and asked how we can have an intelligent conversation when we have no figures.

Is Deputy Martin going to put his question or not?

He said that last year. That is the key point. The Taoiseach does not believe in the public having an intelligent conversation about anything to do with policy or health.

Deputy Martin and his party did it for 14 years.

He believes in delusion. He underfunded the health service. He created-----

Deputy Martin created the HSE.

Deputy Martin is not listening to me. He is way over time. Will he put his supplementary question?

-----the long waiting lists and the trolley numbers but covered it all up by saying that there will be a grand universal health insurance plan, but it will not be delivered within the next ten years.

(Interruptions).

The Taoiseach should tell the truth for once on this issue. He broke his promise and has failed in this key area of Government policy.

The IMF and the troika are not here.

Paddy is not happy, Taoiseach. He is not happy.

(Interruptions).

Settle down. There is no point in getting excited. Would you all settle down, please? Allow the Taoiseach to reply.

I recall Deputy Martin's words when he occupied the Department of Health about the extent of money being put into it. He said there was never going to be enough. I recall him saying he would end waiting lists for once and for all.

The Taoiseach said it would end here.

I recall his personnel, payroll and related systems, PPARS.

We got an awful lot more done than the Taoiseach.

I recall so many things but, at the end of the day, Deputy Martin is the only Minister for Health I can remember who denied responsibility for anything that happened in the Department.

Where is your Minister?

The Deputy ran away from it.

The Taoiseach is out on a wing on this one.

The Taoiseach is Han Solo.

(Interruptions).

Please stay quiet.

Where is the Labour Party today?

I will return to the Deputy's central charge. Yes, the Government commissioned the ESRI to conduct a study on the implications of funding in respect of a particular model of universal health insurance.

It is your model. It is in the White Paper.

Yes. Is anybody infallible? Deputy Martin denied all responsibility for reports commissioned. I accept the report of the ESRI-----

It is not going to happen.

-----and the Government will not continue with that particular universal health insurance funding model.

Your model is down the drain.

The Fine Gael model.

The author of the report pointed out, as we know and as the Minister conveyed to the Government, that there are other models of multi-payer insurance funds that can be examined, and will be examined now.

The Government was told this by the Department of Public Expenditure and Reform. It did not need this report.

In the meantime, we have the challenge of reform and structural changes ranging from hospital groups to money follows the patient and the Department of Children and Youth Affairs-----

Yes, there are waiting lists-----

Children are waiting three years for an intervention.

-----and there is the question of trolleys, the fair deal and the medical cards. All of these matters will have to be dealt with in any event in respect of whatever alternative funding model is put in place.

The Taoiseach provided dishonest budgets for three years.

The Deputy's model is to increase tax and continue with an inefficient two-tier system.

Yours will be much more efficient if you will not treat the people. More will die.

Ours is universal health care funded by universal health insurance, a particular form of money. I reject the Deputy's assertions.

Your efficiency is to let them die.

Does the Taoiseach recall his notorious five-point plan?

Yes. It promised a new health system. It promised to eliminate long waiting lists, the two-tier health system, trolley waits and to introduce a universal health insurance scheme - fair care. Sinn Féin warned that this would not work, as did other parties and independent health experts, but the Taoiseach would not listen. This morning, the Minister, Deputy Varadkar, in a car crash interview said that instead of a concrete plan for health, the Government has a vision. The people languishing on trolleys this morning do not need a vision; they need a solution. The Minister, Deputy Varadkar, like the Taoiseach, offers no solution. He asserted that the universal health insurance scheme remains the Government's preferred model, as the Taoiseach has repeated. This is clearly due to Fine Gael's ideological position which favours the interests of private health insurance companies over the interests of patients and their families. This is a for-profit position. The Minister, Deputy Varadkar, insists that he is merely shelving this proposition. He then went on to say that it would not happen in the next Dáil if, God forbid, the Government is re-elected. He says it might be done in the following Government's term.

Universal health care based on health needs, not on wealth, paid for by direct taxation and free at the point of delivery is the only fair and viable model to deliver the rights of citizens through a truly public health service. Will the Taoiseach take the opportunity this morning to rule out, once and for all, his unfair, for-profit model which patently has been taken off the agenda by the Minister for Health?

Deputy Adams has raised perfectly legitimate questions on health over the years in this Chamber. Many of those questions relate to the inefficiency of a two-tier health system. The Government's view and commitment is to end the two-tier health system, and its commitment is to have a funding model through universal health insurance to pay for that. The Government put forward a particular model of universal health insurance and it commissioned the ESRI to conduct a report on it. That report was prepared and was received by the Government. It sets out the ESRI's analysis of the funding costs and the implications of that for families, insurance and the health system in general. I could argue about elements of transaction, unmet needs or margins in respect of insurance companies, but I confirm that the Government will not proceed with that model of universal health insurance as funding for universal health care.

The Fine Gael model.

The Deputy's and other Deputies' constituents are entitled to a universal health care system that delivers medical attention based on their medical needs-----

When will they get it?

-----as distinct from their salaries, incomes or what they have in their pockets. The way to do that is to put in place all of the building blocks required to restructure a health system that clearly has inefficiencies. There have been problems in respect of medical cards, the fair deal, waiting lists, trolleys and particular cases that arise from time to time.

That has nothing to do with the model.

The Government has moved on reform in respect of children under six years of age and people over 70, removing children from the Department of Health by creating the Department of Children and Youth Affairs, dealing with the stabilisation of the private health insurance market and in many other areas where good things are happening throughout the health system. Clearly, however, there are serious challenges ahead and the Government remains committed to the path of reform, through the implementation of reforms and ending the two-tier health system, and the funding of that through an appropriate, but different, universal health insurance model.

In the dying days of the Government, the Taoiseach has eventually confessed that he has abandoned the scheme he favoured. Let us consider the other promises the Taoiseach has broken. The programme for Government committed to free GP care for all, an end to prescription charges, introducing universal health insurance and the abolition of the HSE. None of this has happened, and none of it will happen. Does the Taoiseach not agree that in the transparent, open and accountable democratic revolution he promised, such abject failure should be a resigning matter? His flagship health policy has collapsed. Will the Taoiseach resign on this issue?

Is Deputy Adams thinking about that himself?

The Taoiseach promised to provide a modern, fair and accessible health service, but he has failed miserably to do that. In 2013, the former Minister, Deputy James Reilly, said we will never again see 569 people on trolleys on a single day while the Government is in office. The Taoiseach made the same promise. Last month, there were record numbers of patients on trolleys, many of them elderly. The Government is responsible for a health service in complete chaos. Is it not time to admit that the five-point plan was a five-point sham? The truth is the Government has no plan, no solutions and now does not even have the pretence of a policy on health.

I am not sure who the Deputy's poet is, but he could do better than that. The Deputy asks me to resign every couple of months.

The Taoiseach will eventually.

I presume Deputy Adams is trying to drive his point home.

In fairness, the Minister, Deputy Varadkar, did too.

In the spring of 2016 I will leave this chair, go to Áras an Uachtaráin and ask the President to dissolve the Dáil. I will be happy to contest throughout the country on the mandate the people gave us to fix our public finances and to put the country back to work.

Will the Taoiseach do a couple of live debates around the country?

I do not know if Deputy Adams has met any parents of children under six years of age.

It will be a tall order in Roscommon.

It is a fallacy.

Is this the fellow with the two pints?

Quiet, please.

They say the introduction of free GP care is a very good thing for their children, as they do not have to pay at the point of access. People over 70 years of age will tell the Deputy the same. The Government has committed that the next stage is to give free GP access to all the children of working families. Some of them might be covered by medical cards already. Clearly, the Deputy does not think that is a good idea, nor does he appear to think that building 45 primary care centres, with others under construction, is a good thing either.

Is universal health care as a right in a so-called republic a good idea?

Perhaps Deputy Adams does not have any concept of what good community care means. He does not appear to appreciate that patients who are able to live at home and have quality home care packages is a good thing. He also does not appear to like the fact that waiting times for the fair deal are now down from 18 weeks to four weeks-----

The Government put it up to 14 weeks.

-----which is a very manageable and fair system.

What we have tried to do is implement a series of measures-----

They failed miserably.

-----in a very challenging position when we inherited the economic mess that the other crowd left us with-----

If his five-point plan was implemented, we would see where we are.

-----to produce a health system that will end the two-tier system and will have universal health care for everybody, so Deputy Adams will not have to go to America the next time he requires this.

Over the last number of years, in this country and other countries in Europe, we heard great talk about a cashless society, where everyone was moving to cards and going away from chequebooks. I know the Taoiseach is an admirer of European policy and he has bought into this idea of a cashless society.

Fine Gael often talks about SMEs. They are the backbone of business across the country. At the moment, the banks have a new Houdini act which they are doing around Ireland with farmers and people who always had chequebooks, telling them of this great idea of a business debit card. When businesses heard of a debit card, it was always in terms of a transaction cost of approximately 17 cent to the business, and they bought into that. Sadly, I have been contacted by many businesses around the country in the past few weeks because the banks have been pushing those new business cards onto farmers and businesses and they have been accepted by merchants and marts around the country. A person can spend €10,000 in a mart on five or six animals, pay for meal at a merchant's or be in the process of building a house with costs of €40,000, €50,000 or €60,000 at the local hardware business. Those cards have been put forward but it is to the detriment of small businesses, who have found a huge charge is being put upon them. One person telephoned me last week to tell me that in the last month, they have lost €2,800 by accepting these cards.

This is a scandalous situation that small businesses have to contend with in this country.

A question, please.

The reality is that if a person is building a house with €50,000 or €60,000 worth of materials, the person that supplied them, that is, the merchant or the hardware business, would pay back to the bank approximately €1,000 of the money they took in because they accepted this card.

It is outrageous.

This is a scandalous situation. As bad as the chequebook situation was, where a person might write five, six or eight cheques and they cost approximately 70 cent each to the person that was writing them, what is happening now-----

Will you put your question, please?

People are being lured in by this new great card they are being given. The people who have accepted them are being robbed by the banks, with what is going on.

Sorry, will you put your question? You are way over time.

I ask the Taoiseach to join with me and make it very clear to businesses, while this con job is going on around the country, in the banks that we have bailed out-----

Thank you, Deputy.

-----that people are told to continue using their chequebook-----

Sorry, Deputy. I will have to cut you off.

The situation at the moment, in most places, be it in marts or in business-----

Deputy, will you please obey the Chair?

-----is that they are not accepting those cards.

Deputy, you are a minute and a half over your time. Would you please sit down? Thank you.

Will the Taoiseach join with me and put out this warning to the Irish people?

Before the Taoiseach responds, I ask the Deputy to respect the Chair when his time is up.

Everyone else talks as long.

Sinn Féin and Fianna Fáil got longer to speak.

I deal with those issues. You mind your own business. I call the Taoiseach.

Deputy Fitzmaurice raises a valid point. I suggest that some of those small businesses and individuals who feel they are being overcharged by banks should raise the matter with the Credit Review Office, which is an independent authority as ombudsman. I get the impression the Deputy is talking about somebody building a house in rural Ireland who does so through subcontractors or by piece work, although one would write more than six cheques to do that, according to people who work in that business.

The Government has a very clear policy about the promotion of SMEs, access to credit for SMEs and the setting up of the local enterprise offices in order that SMEs can do business, set up a business, hire people and make it easier for business to be conducted. The banks have their individual policies and, in respect of mortgages and other issues, people are advised to check the possibility of switching from one bank to another for the offers and benefits they may get. I suppose debit cards are an invitation to continue debiting and, clearly, there are charges and a cost for that.

I suggest this is an issue that should receive some focus from the Credit Review Office and from the Central Bank, which regulates the banking system. If the Deputy wants to give me details of the person he mentioned, I would be happy to follow it up for him.

This is a problem that has arisen over the last two months, where banks have said to their customers, "We are moving from cheque books and we are going to give you this card". Businesses accepted those cards in good faith, believing there would be the normal charge. There is a duty on politicians to explain to businesses what is going on. We do not want to see businesses losing money because some of them are on their knees. I am not talking only about building a house. I am talking about a person going into a mart and paying €10,000, €12,000 or €15,000 for cattle, or about someone paying their local merchant every month for meal.

This is the problem that has arisen. If a person uses the card, it is charged at 1.5% of the total transaction. If it is done over the telephone, they are charging up to 2%. This is coming from banks that we, as the taxpayers, own 99% of. I think there is a duty on us to encourage people to continue to use their chequebooks until this mess is sorted out. There is only one way the banks will learn or get the message. If people do not use the item they are given, and if they stay on the same path they were on, then sooner or later the banks will get the message. This has to come from us, as politicians.

That is why the Government is interested in the future of post offices and credit unions-----

Deputies

It is closing them down.

Tell that to Joan.

-----and the opportunity that exists for people to check the different range of opportunities that banks offer here. Whether we like it or not, we are moving towards a situation where electronic payments become more and more prevalent, and we see them everywhere now.

Why is that good?

Whether people do business from their mobile telephone or on a credit card, it is all moving in that direction. How many people can the Deputy find in a bank any more? The machines talk back at us and so on.

We cannot trust the banks.

The Deputy makes a valid point about businesses losing money. Businesses and their accountants should be acutely aware of the range of systems and options that are open to them. It is an important point. Whether we like it or not, in five or ten years time, we will have moved ultimately to electronic payments.

The Barclays scam of several billion was an electronic one. All the big scams are electronic.

Every retailer and business should be online and every individual now buys much of their ordinary consumer goods online.

The chequebook is going, one way or the other.

He means it is okay for the banks to rip off businesses.

The Deputy is raising the alternative and the consequence, and I take his point.