Leaders' Questions

I call Deputy Micheál Martin, who has three minutes. I would appreciate it if leaders and the Taoiseach observed their three minutes.

On behalf of my party, I also welcome our colleagues from the House of Lords and the House of Commons to Leinster House.

Those in my party are saddened at the loss of the former Deputy, Peter Mathews. I take it that we may have an opportunity to comment later in light of Peter's recent membership of the House. He was a person with whom I and many Deputies got on well. He brought a freshness and a vigour of intellectual thought to the House that were valued. I was saddened to hear of his loss this morning. I wish to extend our fullest sympathies to his family. I hope that we will get an opportunity later to pay a longer tribute to him.

There are many issues of the day.

As predicted, we are rushing headlong into a major industrial dispute with the State bus company, Bus Éireann. The more than 110,000 regular passengers face chaos next Monday. The staff of 2,600 face very worrying times. They are concerned not only about their terms and conditions but the future of the company itself. It seems to them that in one fell swoop an attempt is being made to dramatically and fundamentally alter the nature of the company and the terms and conditions of its workers who perform a very valuable community and social service, in addition to its commercial activities. I put it to the Taoiseach some time ago as to whether the Government is committed to the maintenance of a State transport company, in particular one that provides a very significant service to regional and rural areas. If it does, then a lot of policy implications stem from that.

There have been warnings to the effect that the company is facing insolvency. If it is, that very much comes into the political domain because the Government is the shareholder and the matter would have to come before the Dáil in terms of any actions that would flow from a declaration of insolvency. The stance of the Minister for Transport, Tourism and Sport is not acceptable. He should have intervened much earlier. For the entirety of 2015 plans were submitted to the Department of Transport, Tourism and Sport but were left on the shelf because a general election was due at some stage in the following 12 months. In essence, that is the reason an intervention was not made, one that could have eased the situation somewhat, well in advance of the current crisis, but for political reasons the Government of the day decided not to act on plans that were submitted to it concerning the difficulties facing Bus Éireann. That inaction over a long period contributed to the current situation. The idea that one can do everything in one fell swoop and, essentially, accelerate a race to the bottom with regard to terms and conditions is a bridge too far and is one of the reasons we are now heading towards a major industrial conflict, one that could spread to Irish Rail, Dublin Bus and other companies, which would create chaos in people's everyday lives in terms of getting to work and accessing services. We all want to avoid that.

I put it to the Taoiseach time and again that at a minimum the Minister has a responsibility to set the mood music. One gets the sense that he is silently, on the margins, acquiescing to the demise of a State company - a bus transport company - as his own ideological position is one that does not lend itself to the continuation of Bus Éireann. I hope I am wrong. At the very least the Minister should have engaged on the policy issues such as the application of the free travel scheme and the public service obligation routes and facilitated meetings between his Department, the National Transport Authority, Bus Éireann management and unions to tease out the policy dimension to this issue. There are policy dimensions to it. It is not just simply an industrial relations issue that can be put into its box. I put it to the Taoiseach that that type of initiative is now urgently required. Will he discuss with the Minister the initiatives he can take to ensure a contribution is made by him and the Government to the resolution of this issue?

I too welcome our visitors from across the water here today to the Dáil. I hope they enjoy their visit. They may have issues to talk about in respect of Brexit and other matters.

I assure Deputy Micheál Martin that there will be an opportunity to pay tribute to our late colleague, Peter Mathews. I extend our deepest sympathy to his wife Susan and family. He was always a different personality with a particular view in respect of financial circumstances as they applied to the country.

I agree with the Deputy in respect of his question on Bus Éireann that no one wants a strike to happen. It is a matter of grave concern to the Government and to commuters who travel on Bus Éireann that a strike might happen. I assure Deputy Micheál Martin that the Government is committed to a State transport company. A total of 81% of passengers who travel with Bus Éireann use the PSO-subsidised service. As he is aware, it is not possible to subsidise the commercial arm of the company, namely, the Expressway service in the context of Europe and where we are.

I do not agree with the Deputy or accept his comment that the Minister is on the margins silently acquiescing in the demise of a State company. The Minister is but one member of a Cabinet that acts with collective responsibility here. The Cabinet is fully committed to the retention of the State company. In respect of the statements made yesterday by the board, company and trade unions, there is a willingness to engage in the kind of serious discussions that we all understand need to happen to solve this particularly difficult situation. As I pointed out on several occasions, the WRC is ready, as ever, to assist.

There are some in the House who repeatedly claim that the Government and the Minister should do something. When asked what the focus of that particular attention is, it is always about increasing subvention and assessing the free travel scheme. I have already pointed out that the subvention has increased to €40 million and that there is no danger to the free travel scheme. The PSO subvention increased by 11% this year and 13% last year and Bus Éireann has benefitted from a 21% increase in its subvention in 2016. The subvention applies to PSO services only and cannot under law be provided for commercial services. If Expressway is losing €50,000 per day, it is a matter that needs to be addressed. The WRC stands ready to negotiate and discuss with the union and the board.

The Ministers for Transport, Tourism and Sport and Social Protection have already made it perfectly clear and have advised their officials to report back very quickly on the funding of the free travel scheme, to which there is no danger. There is no amount of ministerial action that will resolve the issues internal to Bus Éireann. These issues can only be resolved through direct and realistic negotiations between employer and employees. In respect of rural Ireland, it has already been made perfectly clear that any changes to the Expressway services will be taken up by the National Transport Authority, which will step in and assist in cases where connectivity is threatened. Some Deputies alleged last week that this was an attack on rural Ireland. The public bus service in rural Ireland is expanding through increasing the amount of PSO funding to Bus Éireann and providing a 24% increase in funding for the rural transport scheme. I hope everybody will assess this seriously and take the WRC-----

I know it is an important issue but we are constrained by time.

The Grant Thornton report was submitted to the then Minister for Transport, Tourism and Sport, Deputy Donohoe, and others in January 2016 and the Government sat on it. Why? It was because of the general election. The Government did not want to deal with it. It went on for a full year and a bit and then in one fell swoop, the Government has stated the workers will take the brunt for the entirety of the issues facing Bus Éireann. That is what is happening here. When the Minister for Transport, Tourism and Sport, Deputy Ross, announced his Estimates for Bus Éireann, he never once alerted anybody to the crisis facing Bus Éireann. Read the press release he issued on the day. It is full of self praise - "I'm doing this, I'm doing that." Did he once alert anybody that there was a crisis coming down the tracks that his predecessor and the Government knew about? In essence, regardless of whether it likes it or is transparent about it or will tell the truth, the Government is presiding over the demise of Bus Éireann as a public transport company. Many within Fine Gael probably agree with that, which is probably at the root of the inertia on the Government side. It is acquiescence in the undermining of the company and the reduction in workers' terms and conditions in one fell swoop to levels that are not fair or acceptable. I find it extraordinary that the Independent Alliance is presiding over and standing by that and is not insisting on a proper policy perspective on this issue. If a State company is going to become insolvent, it de facto becomes an issue for this House and the Government.

A total of 81% of passengers who travel on Bus Éireann travel on a PSO-subsidised route and that subsidy has increased. Rural transport throughout Ireland is increasing and there is an increase in the subvention every year. The problem here, as the Deputy is well aware, is that the Expressway service is losing €50,000 per day.

That needs to be addressed. Who can address that? The WRC stands prepared to take unions and management in there now and discuss this question as to how one might make adjustments and changes to bring about a better situation than one has now. The National Transport Authority, as I have already stated, will assist and assess any changes that occur that arise from changes to the Expressway service. Has the Deputy not heard the people on the national airwaves talking about 45 or 50-seater buses down narrow country lanes? There needs to be a change of assessment as to whether that is valuable or whether it is not.

That is not happening in my area.

Clonmel to Dublin, narrow country lanes.

If the issue here is the Expressway service and it is losing money on a daily basis, that needs to be addressed.

The Taoiseach is proud of it. There are 55 actions. It goes much more beyond the Expressway service.

Westport to Athlone, narrow country lanes.

The drivers and those who service Bus Éireann throughout the rest of the country carry 81% of the passengers who travel on Bus Éireann and they do so in a professional, diligent and competent fashion. The nub of the issue needs to be addressed and the WRC stands ready to accommodate both sides to see can we avoid a major strike next week which nobody wants.

Can I also say how sorry I was to hear of the passing of our former colleague, Peter Mathews? Peter was a gentleman to his fingertips. We extend our condolences to his wife, Susan, and to his family. Ar dheis Dé go raibh a anam dílis.

Earlier this morning the HSE published two reports into failures at a foster home in Waterford over the course of almost three decades. During that time the foster home in question housed 47 children, one of whom we know as Grace, a young woman with profound intellectual disabilities. She was left in that home for nearly 20 years despite a litany of sexual abuse allegations and neglect. Grace was forgotten, abandoned by those in the health service charged with ensuring her care.

The findings of the reports published today are shocking. For long periods of time, there was no intervention or interactions with Grace and the various persons who were directly involved in her case failed to discharge their duty of care to her. Both reports published today stress the cases of four other service users relating to allegations of sexual molestation and physical abuse and an allegation from one man that he was locked in a cupboard. All the while, serious breaches of all reasonable practices took place and nothing was done.

These details were brought to the Taoiseach's attention at Cabinet this morning and he will be well aware of them. No doubt he, like everybody else, is deeply shocked by the contents of the two reports.

A commission of investigation has been long promised by Government and I welcome that it is to be set up in the coming weeks. However, what we need here is accountability. Reports and commissions are necessary and fine, but there are clear-cut instances of abuse of the gravest kind here, both in the treatment of Grace and others in foster care and of the failure of health officials to ensure her care and safety. Who is responsible?

We also have what is alleged to have been a cover-up. Last year's Dignam report stated of the two reports published this morning that there were shortcomings in them and that there was an allegation that crucial files may have been deliberately destroyed by persons unknown. That is a disturbing and damning allegation.

The five-year delay in the publication of these reports is, we are advised, as a result of Garda concerns that they may impact on criminal investigations. Can the Taoiseach tell us today where are those criminal investigations at? Have arrests been made? Do they concern the abuse, the cover-up or both? Who in either the HSE or any other State agency has been held responsible? It is not enough for us to produce shocking reports. God knows, we have had enough of them. We need to know who is accountable and that he or she is, in fact, held accountable.

First, the least this House can do is apologise to Grace and her family. Her treatment is a disgrace to us, as a country.

The Minister of State at the Department of Health, Deputy Finian McGrath, requested the HSE to publish the Devine and Resilience Ireland reports following his receipt of the Dignam report in early November last and following discussions with the Garda Síochána, the HSE has been able to publish the redacted reports today, 28 February.

The Government is committed to the establishment of the commission, which we agreed to set up on 2 February 2016. Following the disclosure and the seriousness of the matter, the Government agreed to set up that commission of investigation. The Minister of State, Deputy Finian McGrath, will bring those terms of reference to Cabinet next Tuesday. The HSE apologised today to anyone who experienced serious failings in the care received and for the significant failures of the former South Eastern Health Board.

The Oireachtas has passed a number of items of legislation dealing with issues about this area including the Criminal Justice (Withholding of Information on Offences against Children or Vulnerable Persons) Act 2012, which makes it an offence to withhold information on serious offences committed against a child or a vulnerable adult; the National Vetting Bureau (Children and Vulnerable Persons) Act 2012; the Criminal Law (Sexual Offences) Act 2017, which includes stronger sanctions aimed at protecting children from sexual exploitation, child abuse material and online grooming, was passed by the House at Christmas and signed into law by the President last week; and the Children First Act 2015, which placed key elements of the Children First national guidelines on a statutory basis, has been enacted. When fully commenced at the end of this year, the latter Act will provide for a number of key child protection measures. The Government also established the Child and Family Agency and children have been recognised as individuals in their own right under the Constitution for the first time.

The policy in respect of intellectual disability, Safeguarding Vulnerable Persons at Risk of Abuse, launched in December 2014 provides one overarching policy to which all social care services, including those provided directly or indirectly by the HSE, have subscribed and implemented in their places of work. This has ensured that there is now a consistent approach to protecting vulnerable people - it is a no-tolerance approach to any form of abuse or neglect - and a culture which supports this ethos.

The national guidance on host families in community settings recommendations were made in 2011 and updated in 2012. Ms Leigh Gath is the confidential recipient who will examine concerns and offer help and advice to vulnerable adults or anyone concerned about a vulnerable adult in a HSE service or a service funded by the HSE. The HSE is also establishing a national implementation review panel.

Deputy McDonald asked if arrests have been made in respect of any criminal activities. That is a matter for the Garda Commissioner and the Tánaiste and Minister for Justice and Equality to report on. I do not have information in respect of arrests following criminal activity or any case that was being pursued.

The two reports speak for themselves, and they are shocking. As the Deputy is aware, when Mr. Dignam reported back in September 2016, there were a number of legal procedural issues to be dealt with. The Minister updated the Government. They are now published, admittedly in redacted form, and next week the Minister of State, Deputy Finian McGrath, will bring the terms of reference for the commission to Cabinet for approval and before the House subsequently.

I thank the Taoiseach for that answer. I acknowledge, and let it be acknowledged, that the standards and the law protecting our children has become ever more robust over the years. I acknowledge also that the Taoiseach is establishing the commission of investigation and that the Minister of State, Deputy Finian McGrath, will bring forward the terms of reference for it, but there is the rub. The question for people who woke this morning to read again about Grace and the 20 year ordeal she faced and that was faced by other vulnerable children in the care of the State is who is accountable. The worry for many people is that we enter into another process of a commission that comes out at the far end with zero in terms of accountability. That is why I asked the Taoiseach about the Garda investigation. We need to know the status of those investigations. We do not need every detail but we need to know why the Garda Síochána deems it appropriate now for these reports to be published. The citizenry need a sense of assurance that when offences of the gravest kind such as these come forward that the full force of the law is not just stated but is actually enforced.

Is there some mechanism by means of which the House can be informed as to the status of these investigations?

I expect that the Tánaiste and Minister for Justice and Equality, on receipt of information from the Garda, will reply to any questions in the House about this. It is true to say the reports into the Grace situation were delayed because of an understanding to the effect that they might interfere with criminal investigations being conducted by the Garda. That matter was pursued by the Minister of State, Deputy Finian McGrath, and ourselves on number of occasions. Advice was then made available which indicated that it was not necessary to wait and that the reports could be published - in redacted form, admittedly - and the Dignam report and the Resilience Ireland report speak for this. The answer to the question is that I cannot say what is the nature of the criminal activities being pursued. I cannot advise the Deputy as to whether people were arrested, but I am sure the information will be made available in its general form to the Tánaiste and Minister for Justice and Equality.

I wish to address the topic of governance in the HSE. There are serious governance malfunctions and, in many areas, an absence of good governance in the health service in general. The OECD has found that Ireland has one of the highest spends on health services, yet it has some of the worst outcomes when it comes to accident and emergency treatment times, delayed admissions - with patients left waiting on trolleys - waiting lists for consultations and waiting lists for planned elective admissions. The latter was starkly illustrated two weeks ago by the delay identified in scoliosis surgery for children. Many other patients suffer in silence.

There is lack of clarity in the governance structures between the Minister, the HSE and the Department of Health. The HSE board has been abolished but the HSE continues to operate, seemingly at arm's length from and independent of the Department. There is no certainty in the HSE and its future existence is unclear. The HSE was set up to centralise decision-making and to have consistency in the delivery of services throughout the country. This has failed because our services are as fragmented as ever. Many HSE officials work in an interim or acting capacity and are unclear about their roles and functions. This leads to a lack of trust and undermines any governance consistency. It leads to a lack of trust by patients and by front-line staff.

Hospital groups have been created but most do not have fully functioning boards. It is unclear whether they will become trusts. Community health organisations do not coincide with hospital groups in geographic settings, thus blurring areas of responsibility. The interaction of individual hospitals within groups is poorly defined and model 2 hospitals can be starved of funds and resources while services in larger hospitals are given priority. Hospital services and primary care services seem to work from different budgets and there is no integration. This poor governance leads to substantial inefficiencies in the system and accounts for poor value for money, as identified by the OECD, and leads to much poorer outcomes for patients.

Poor governance decision-making costs money but there is no transparency or accountability in the governance structures of the HSE to account for inefficient spending. Cost-benefit assessment applies to the provision of drugs such as Orkambi and Respreeza, but no such cost-benefit analysis applies to governance decisions. If we demand clinical excellence, we should also demand governance excellence.

We cannot expect this to be provided on a voluntary basis and it must be underpinned by legislation to ensure that good governance is rewarded and bad governance is eliminated. When does the Taoiseach intend to put in place legislative structures for the governance of the HSE?

Deputy Harty, as a medical practitioner, speaks from a position of knowledge in respect of many of the issues he raised. We will put €14.5 billion into the health system this year, more than ever before. In some cases, the response is not what we might expect in terms of the excellence in governance and other areas to which the Deputy referred. The work that he spoke of is part of an ongoing process.

This morning the Cabinet approved legislation dealing with a reduction in prescription charges for those over 70, and we approved the inclusion in that Bill of 10,000 medical cards for children in receipt of domiciliary care allowance. There are reports showing a dramatic reduction in cancer rates among children compared to a few years ago. If we were to start with a greenfield situation we might organise the structure of health services around the country in a very different way but many hospital facilities are now state-of-the-art. A major infrastructure programme is to be carried out in the future and we are building a range of primary health care facilities around the country, which are expected to operate on a full-time basis so that people do not have to go to hospital in the first place.

Nobody could disagree with the Deputy's principle of clinical excellence matched by excellence of governance. There has to be an administrative capacity to back up clinical excellence and there is always a demand for this capacity but for many years this country has been behind in its digitisation capacity, whereby we could save time, create efficiencies and make people aware of the scale of what we do. Those at the front line provide a service beyond criticism and those who have moved through centres of excellence will point that out. With an ageing population there are always difficulties and that is what an effective, high-standard health care system is about. The Minister for Health, Deputy Simon Harris, and his Ministers of State are working diligently on this so that we can have a healthy, active and understanding Ireland and can have medical facilities and services as close to people as possible. It is not perfect, by any means, but it is the source of the allocation of €14.5 billion in 2017, an extraordinary amount of money for a small country.

The legislation to which the Taoiseach referred underpins decisions made by the Dáil. I am referring to legislation underpinning decisions made by the HSE and concerning how it administers its funds. There are many examples of where funds are not delivering services, such as in respect of emergency department overcrowding, bed capacity issues, recruitment and retention of staff and the lack of diagnostics. In the mid west the HSE, by closing GP access to medical assessment units in Ennis and Nenagh, is making decisions which compound overcrowding at the regional hospital in Limerick. It makes no sense and ambulances are rushing up and down the road delivering patients to hospitals which are inappropriate to their care.

The children’s hospital development is another case in point because a cost-benefit analysis was not done on the question of building on a brownfield rather than a greenfield site, and a huge amount of money is now going to be spent on building a hospital which could have been more cost-effectively built on a greenfield site.

The Grace case is the most recent illustration of a lack of governance in the HSE. The problems were identified but they were ignored and hidden and, ten years on, we have investigations and commissions which are costing huge amounts of money and which could have been avoided if there was proper governance within the HSE. I ask the Taoiseach to introduce legislation to underpin HSE decisions.

Accountability rests with the Minister for Health of the day, because the Vote is now back under his responsibility, not that of the HSE.

This means questions can be answered in the House and the trend of spending in the relevant services is determined by the Department, which is also answerable for that spend.

That is not true.

Twenty years ago we were negotiating the provision of a new national maternity hospital which has now been agreed and will go ahead with a state-of-the-art, world-class facility for expectant mothers and their babies for many years to come. There were discussions for many years on the national children's hospital and this will cater for the children of the island for the next 50 years.

That represents an investment in 25% of the population to have world-class standards for them. We have not built a new hospital since 1998. Additions are necessary and fine, but it is important to have governance to back up the clinical excellence about which Deputy Michael Harty spoke.