Leaders' Questions

Before we start, I remind Members that the time allocation today is only 15 minutes. When the leaders have had an opportunity to come in - I am obliged to call them first - there will be many disappointed Members, but I will have to cut off the debate. However, I will take the names of those offering.

None of us knows if this is the Tánaiste's last day but I certainly wish her luck. I also wish the candidate she did not prefer who is sitting beside her luck.

For the past few years consumers have been offered all sorts of deal to entice them to buy cars. Some deals are better than others. Personal contract plans, PCPs, encompass the initial front-loading cost of buying a new car and an expected residual value to reduce the amount borrowed. Dealers in Ireland are saying that as many as 70% of new car sales are based on PCPs. They are saying also that up to 30% of car finance packages are based on PCPs. Some car loan providers have better practices than others. Some require a 20% deposit, while others require less. A customer normally makes a monthly payment and must at the end of the term of the plan make a final substantial payment. Ownership does not transfer until the last payment is made. The plans normally last for about three years. There was a surge in car sales in 2014. Many of those who bought cars in 2014 are coming to the end of their PCPs and, as per the contract, are now being forced to make a bubble payment.

Now it appears US regulators are very worried about this issue and some in the United States financial services market are predicting a possible financial collapse as a result of the number of defaults on car loans. The car loan market in the United States is worth $1.3 trillion, but the big banks seem to be pulling back a little because many consumers have taken on more debt than they can handle. We know that the Bank of England is also concerned about the issue and examining it in terms of the impact it could have on the financial market. According to media reports, the Society of the Irish Motor Industry is carrying out its own report on the issue. We also know that in Ireland, PCPs are completely unregulated. The story I have set out for the Tánaiste which I have set out before about nervousness in the United States and the United Kingdom and the Government looking the other way is one we have heard before. What is the position on PCPs for consumers purchasing cars? What is the answer for those who may not be able to make the bubble payments that are now arising or will arise next year or the following year? What is the remedy for consumers who have been mis-sold these products in the past few years or who have not received the professional advice they might have expected? That professional advice has not been required by the State because the sector is completely unregulated.

I thank the Deputy for observing the time limit.

I thank him for his interest in the Fine Gael leadership election.

We have a strong interest in it.

I hope all other parties will show the same level of transparency, democracy and excitement in their leadership elections as we have shown in the course of ours.

It is a Punch and Judy show.

The clock is running.

(Interruptions).

By the way, I believe it is Deputy Thomas Byrne's birthday. I wish him a happy birthday.

The clock is counting down.

The Deputy spoke about personal contract plans. I have noted, as he said, that the issue has been raised in other countries. I have heard the debate in the United Kingdom about them. There is quite a lot of concern that people may be taking on unmanageable debt. I appreciate the Deputy raising the point which has not received very much coverage in this country but it is one to which the public needs to be alerted and of which it needs to have a greater awareness. There is also a need for awareness of the matter at Government level. We are talking about a financial product. Like all financial products, we must ensure people are properly informed and are not taking on unsustainable debt. PCPs can be very good because they make new cars affordable and many are happy to enter into such arrangements. However, if they are too easily available or people are not aware of the consequences and cannot afford to repay their loans, as has been found in other countries, they can lead to people taking on unsustainable debt. It is essentially the responsibility of the Financial Regulator who oversees such products. If there are issues arising or it is found that the products offered in this country are not reaching the appropriate criteria and standards, it is up to the Financial Regulator to take further action. I will raise the matter with the Minister for Finance and ask him to revert directly to the Deputy because it is a very real issue which, as I said, has created considerable concerns in the United Kingdom and elsewhere.

I also thank the Tánaiste for observing the time limit.

With all due respect to the Tánaiste, that is an utterly pathetic answer. PCPs in Ireland are not regulated as specific products. The Central Bank is telling journalists who ask the question that it is not responsible, that they are a matter for the Competition and Consumer Protection Commission. The Government has no figures whatsoever for how many of these contracts have been entered into and we cannot get them. My colleague, Deputy Michael McGrath, has written to the Central Bank to see if figures can be obtained. That is the reality; it is like the Wild West and the Government is sitting back and doing nothing. If someone goes into a garage or to a motor dealer, the encounter is not regulated in any way. This has been a huge gap in the market in terms of regulation in the past few years. Fingers have been pointed at other parties for standing over a lack of regulation but this has been happening since 2013 or 2014 since these products came onto the market.

There has been no Government regulatory response.

There are significant worries in the United States, the Bank of England and the motor dealers' association in Ireland. I assume that if people cannot pay these bubble payments and cars go back on the market it will have severe adverse consequences for motor dealers. The truth is that second-hand car prices are collapsing because of the large numbers of cars being imported from the UK. That is having a very negative effect and there are no answers from the Government.

As the Deputy is well aware, there has been an increase in car sales although there has been somewhat of a decrease this year.

There are no figures on finance.

Yes, but anybody who puts a lending product into the Irish market has a responsibility. This issue is now becoming more relevant because of the increase in car sales. These products are available. As the Deputy said, people can access finance in an easier way than before when they buy cars from garages. Given the improving economy, people want to change their cars and so on.

The Deputy has made a relevant point. It is an area that needs further examination. I will see what the Department of Finance has to say about it and whether figures can be collected in a way that is appropriate in respect of this issue. As I said to the Deputy, I recognise the potential risk for people in terms of debt and taking on debt that is unsustainable.

It is important that there is transparency. If regulation is needed, it should be put in place. As the Deputy said, this is an emerging area. I will ask the Minister to revert directly to the Deputy and see if figures can be gathered and an assessment can be made as to whether there is a problem that would put people at risk in terms of this product.

Yesterday, the Committee of Public Accounts witnessed the toxic shambles that is senior Garda management. As we watched that theatre unfold, word came through of a shooting on Dorset Street in Dublin's north inner city, which claimed the life of a man. This ruthless murder was another shocking incident in broad daylight at the heart of a community caught in the grip of a criminal feud that has spiralled out of control.

There is no excuse for the fear inflicted on the people of the inner city by criminals who flout the law and put the lives of innocents in jeopardy. Those responsible for this shooting must be brought to justice. I appeal to anyone who has any information whatsoever to bring it to the Garda. The Tánaiste and Minister for Justice and Equality cannot stand idly by while these gangsters walk our streets with impunity, take life without fear of being caught and have families and communities living in fear. The actions of those involved and these crimes are an affront to the spirit of the north inner city, our communities, families and all who inhabit this city who have had enough.

It is the Tánaiste's responsibility, as Minister for Justice and Equality, and that of Commissioner Nóirín O'Sullivan to ensure that safety and good order is achieved sooner rather than later. The violence must be brought to an end rapidly before any more lives are lost. The Tánaiste and Commissioner must dedicate all of the appropriate resources to dealing with the violent criminal gangs in our capital city. So far, they have been far too slow to respond to the fear that now exists in the community. People are terrified, which is unacceptable.

Garda numbers have been cut across the State and in the north inner city. Garda stations have been closed. Fitzgibbon Street Garda station has been closed since 2011. There have been severe cuts to community services and organisations which deal with young people at risk. Far from supporting the community, the Government is contributing to an environment in which this violence flourishes.

The Tánaiste must recruit and resource the Garda in the area as a matter of urgency. There must also be a whole-of-Government response and approach. Last year, I put it to the Tánaiste to establish a task force in the north inner city, with a multiagency approach which listens to the community and offers support and which has a long-term plan to find strategies and provide resources to make the community safe.

Sadly, the Government did not listen. The Government's response to the north inner city has been superficial and tokenistic and the violence and the suffering go on. People have had enough of promises and expressions of shock and horror from these benches. Is the Tánaiste now listening and will she now finally commit to resourcing a proper task force for the north inner city?

For 30 years our gardaí and Defence Forces sought to prevent people getting involved in shootings and terrorist activity across this country. They dedicated themselves to preventing those murders. Unfortunately and despite that effort, they were unable to prevent some murders. However, they certainly helped to maintain the peace and protect communities. Our gardaí are doing the very same now. I abhor and condemn the fatal shooting yesterday, the circumstances in which it took place and its callousness. Unfortunately, this is what our gardaí are confronted with, namely, criminal gangs which devastate communities by importing drugs and which are determined to murder one another.

There is no question of standing idly by. The Government has committed enormous resources to the north inner city and the armed response unit is working flat out, morning, noon and night, to keep people and communities safe. It has prevented a large number of planned killing. Unfortunately, it is the case that criminals continue to plan to murder one another as we see in this criminal situation with these gangs. I am absolutely committed to ensuring that gardaí will make every effort to bring the perpetrators to justice. I agree with the Deputy that anyone with information on this should bring it to the attention of An Garda Síochána.

For our part in government, we are determined that gardaí will continue to be properly resourced to deal with the many challenges they face, including the scourge of these violent gangs. We have shown that by the number of patrols across Dublin and the country, the recruitment of 900 extra gardaí this year and the provision of increased resources and supports for gardaí, including new vehicles. Every effort will be made and no resource will be spared to deal with this scourge. Gardaí have done this in Limerick before where people are serving and have served prison terms in relation to 24 out of 25 murders and I have no doubt they will be successful in dealing with the current threat from these gangs.

It is particularly disingenuous of Deputy McDonald to talk about the lack of resources going into the north inner city when this area was ignored for so many decades. She can see what the Taoiseach and the Minister for Public Expenditure and Reform, Deputy Paschal Donohoe, have done in the last nine months to a year in the provision of new resources for schools, youth services, diversion projects and housing in that area. It is particularly disingenuous to fail to acknowledge the resources being provided. The Taoiseach spent half a day recently looking at these projects and it has been acknowledged by local councillors and others that the resources have been made available there.

I am aware that the Taoiseach was in the north inner city on Monday. Perhaps in the most grim way possible, the fact that there was a shooting on Wednesday actually serves to highlight the tokenistic and superficial approach of the Government over the last year.

So there is no misunderstanding, local people are well aware of that fact.

Local people are well aware of the good being done by the Taoiseach and the Minister, Deputy Donohoe.

Can the Leas-Cheann Comhairle ask the Government benches to contain themselves?

The Tánaiste not the Minister of State, Deputy Byrne, is delegated to take questions.

Far from a determined approach to tackle the issues, it seems the Government imagines people in the inner city will be happy with crumbs from the table, with a small bit of attention and with a few bob thrown here and there. That is not good enough. More importantly-----

What have you done for them? Deputy McDonald has done nothing for them in all the years she has been here.

Deputy McDonald is a disgrace.

She is a disgrace, the Minister of State is right.

It is Deputy Mary Lou McDonald she is speaking about.

Please allow the Tánaiste to respond.

They have obstructed me in putting my-----

There is no injury time today.

Apart from it being an insult to the people of that part of Dublin, more to the point, it is not going to work.

I cannot allow the Deputy-----

The north inner city coalition has set out in great detail-----

Unless the Standing Orders are changed-----

It is very unfair that they can shout me down and that my time has been eaten up in that way.

As if the Deputy has never shouted anyone down.

I suppose that is the Blueshirts for you.

The Deputy was given some injury time.

It is very hard to listen to her. She sat at the public meetings and never opened her mouth. I was present at them.

I cannot allow the Minister of State to speak.

As usual, Deputy Mary Lou McDonald is dividing communities. She cannot acknowledge the positive initiatives that have been taken. There is the usual negativity and she cannot even acknowledge the huge initiative that has been taken in the north-east inner city.

There is a lot of lobbying today for ministerial positions.

In less than one year we have seen a huge number of short, medium and longer term measures and the community recognises this. When I attended meetings with the Taoiseach and the Minister, Deputy Paschal Donohoe, it acknowledged the importance of the initiatives that were under way and the investment being made. Unlike Deputy Mary Lou McDonald, it actually acknowledges that there is a long way to go. There were 30 years of under-investment.

It will not be dealt with overnight.

Fine Gael has been in government.

Clearly, there is huge-----

(Interruptions).

Perhaps for a change Deputy Mary Lou McDonald should try to acknowledge some of the positive things that have happened.

What about Sinn Féin's responsibility in the North.

Does the Minister of State know where it is?

The Deputy is getting very tetchy. He might explode.

Please, Deputies. I know that we are off next week.

There is a lot of tension in Fine Gael this weather. It will all be over next week, folks - just relax.

I refer to the report on the future of health care, the Sláintecare report. I am concerned there has been very little reaction from the Government to it. I know that it is only two days since it was launched, that it will be presented to the Cabinet next week and that it will be in debated in the Dáil on 16 June, but it is very important that it be kept to the forefront. It is much more than report; it is a blueprint for reforming the health service, the people's health service. We must understand why reform is absolutely necessary and must be implemented, not next year or sometime in the future but now. Soon our ageing population will overwhelm primary care and hospital services. Trolley queues are endemic in hospitals and there are lengthening waiting times in outpatient departments and for procedures. The report is a blueprint for reforming the entire health service, not just bits of it to satisfy crises when they occur. If a problem for scoliosis or cycstic fibrosis patients is highlighted, it is partially dealt with and if the trolley queues are longer than usual, they are partially dealt with, but there is no overall plan for the health service.

The report clearly identifies the need for change. Additionally, it outlines a ten-year vision for transforming the health service. It gives direction and impetus. We must move away from fragmented, disjointed and incoherent health service planning which lacks cohesion and credibility. We must address the lack of capacity in the system. It is a cross-party report. The reform programme needs political commitment at the very highest level, from the new Taoiseach's office, to drive it forward. We have had three Fine Gael Ministers for Health in the past six years and they have all failed to reform the health system.

The strength of the reform programme is that it challenges everybody to engage in cultural change. It challenges the Government, the Department of Health, the HSE, doctors, nurses, hospital and clinical management. It demands a lot from people but it also promises fairness and equality. We must have a health service of which we are proud and people will not be afraid. It will not be cheap but doing nothing will prove much more costly. The Sláintecare reform programme plans to respect the patient and staff in equal measure and will reward those in the public service fairly for their hard work. Spending money on an inefficient system gives very poor value for money.

We must spend money on transforming our service into a new, coherent and patient-responsive one. Can the Government commit to this reform programme and what is its response to it? The country is waiting for the Government's response and the Government will be judged on how it acts in transforming the health service.

I acknowledge the Deputy's expertise in this area and the work done by Deputy Shortall and the members of the Committee on the Future of Healthcare. The country would be pleased to see an all-party approach to health. Every citizen and every Member wishes to have a health service as described by Deputy Harty, that grants equal access, is fair and provides a good service. When speaking about health I always make the point that many good things are happening in our health service and I have no doubt that the Deputy would be the first to acknowledge that. There have been tremendous improvements in cancer care and dealing with heart attacks and strokes. There have been huge initiatives and extra funding. The Deputy spoke about the need for a coherent approach that would be continued across Governments and Ministers. If we could arrive at that point, it would be welcome.

I refer to what the Minister for Health, Deputy Harris, said. When the committee's report was published earlier this week he acknowledged that he had wanted to see support from across the Houses of the Oireachtas for a cross-party committee to work on a ten year strategy. He said, "I firmly believe that this is the last chance of this generation to get this right and to take the politics out of health". We have agreed that there will be a full day debate on Thursday week on this important document. Clearly, it includes many suggestions. One of the proposed initiatives, a greater focus on primary care, is already the goal of the Government and funding and priority have been given to that. However, the report goes into greater detail in that regard. Other areas identified also concur with the Government's policy. We have a ten-year plan but clearly issues arise relating to, for example, the funding of it, the timing, the pace and the priority areas. We will benefit from the discussion in the House and if a second day is required we will provide for that as well.

The Government has given an initial welcome to the report but has not yet had an opportunity to consider it in detail. It certainly will do that.

I acknowledge that there have been huge improvements in some sections of our health service. The difficulty with planning the health service is that it is fragmented. There is a lack of integration and of an overall plan in the health service. A ten-year vision for the service is lacking. We move from crisis to crisis and from year to year. There are annual budgets but there must be multi-annual budgets. There must be a new framework for how we fund the health service. Underpinning that, there must be governance, accountability and answerability in the service. We must introduce legislation. The most important aspects of this report are the introduction of legislation and the establishment of an implementation office. If an implementation office is not introduced within the first three months of the report being published, we will know whether the Government is serious about this. We must have this reform driven forward and introduce legislation, governance and accountability, which is sadly lacking in our health service. I earnestly request that the Government take on a ten-year vision for change and not allow our fragmented service to continue.

When the committee was doing its work, it invited many experts to its meetings and received the contributions of many stakeholders in the area, including health care professionals, academics and other interested parties. Undoubtedly, that contributed hugely to the report. The Government acknowledges the level of expertise that went into framing the report so it must be taken extremely seriously. I believe every Member of the House would like to see a ten year plan to which everybody would adhere and work. There are issues, of course, and we will have the debate on Thursday week. The Deputy's point about an implementation office is very well made. It also requires a whole-of-Government approach because funding is such a huge issue.

Clearly, the Ministers for Finance, Public Expenditure and Reform, and Health, and the other relevant Ministers have a key role in future funding. The funding needs are great; there is no question about that. It is an extra €1 billion this year. We are seeing considerable sums of money going into our health service. We have to make sure the reforms are happening and that the money is well spent.

On a related matter, a couple of months ago when news first broke about Government proposals to hand over governance and ownership of the new national maternity hospital to St. Vincent's Healthcare Group group, the public reacted with outrage and disbelief. That reaction centred on two points. The first was the inappropriateness of a religious group having any role in the governance of a public maternity hospital and the second was the profligate manner in which the Government viewed it is acceptable to gift a valuable asset — a State asset — to private interests.

We have not heard the Government, including the Minister, on this week's developments but we have heard from St. Vincent's Healthcare Group. It stated that, despite the departure of the Sisters of Charity, the terms of the Mulvey report would still apply. St. Vincent's Healthcare Group is a private corporate body. It has no right to dictate the Government's public policy. A public hospital funded by the public for public patients should, of course, remain in public ownership.

There is, however, a wider context for public disquiet over giving away a €300 million asset to this private body. The corporate entity known as St. Vincent's Healthcare Group has been under audit by the HSE for some time. Concerns relate to the entanglement of St. Vincent's University Hospital and St. Michael's Hospital, both public hospitals, on the one hand, and St. Vincent's Private Hospital, on the other, and to the suspected cross-subsidisation from public to private. The director general of the HSE told the Committee of Public Accounts in April 2015 that the private hospital was "being run on the back of the public hospital". He described it as having a "parasitic dependence on the public hospital", to such an extent that it may well not be viable as a public hospital in its own right. Many questions remain. The HSE still has not been informed about the detail of the charge created on St. Michael's Hospital by St. Vincent's Private Hospital in favour of Bank of Ireland. What about the financial arrangements within the group and the top-ups and salary scales in operation? A review of suspected breaches of contract in the context of consultants' work is to begin shortly.

St. Vincent's Healthcare Group epitomises many of the structural problems within the Irish health care system. The need to disentangle this dysfunction was a key recommendation of the Committee on the Future of Healthcare. Does the Tánaiste not accept that it would be highly imprudent to contemplate exacerbating the anomalous corporate governance arrangement within St. Vincent's Healthcare Group by adding yet another public hospital to its portfolio of assets?

The decisions that have been taken are extremely important in terms of the separation of the influence of any religious body on our health services. Everybody here will welcome the decision announced this week by the Sisters of Charity to end their involvement with the St. Vincent's Healthcare Group. It is a very significant development for the whole health care sector. It deals with the concerns raised regarding the question of religious influence in the new national maternity hospital. The sisters will relinquish their shareholding, and ownership will be transferred to a new company with charitable status, to be called St. Vincent's Hospital. The sisters have confirmed that they will not have any involvement in the new company or in the operation of the new maternity hospital. It is very important that this has been completely clarified. There is to be no influence within the hospital or the new body with charitable status. That is very important.

As the Deputy knows, there has been very extensive engagement on this issue under Mr. Kieran Mulvey and with the Minister.

The Minister continues to look at a number of issues and will be reverting. He should be given the remaining time to continue that work. The Deputy makes a broader point about the ownership of hospitals in this country. We do have a long history of a combination of having public hospitals as well as voluntary hospitals. We have at least 17 voluntary hospitals in this country and it is a well-established way of delivering services.

It should not be.

Deputy Shortall raised the question of whether that should be changed in the case of this particular hospital. There are complicated issues involved in that but, as the Deputy said, the health care report addresses this issue of the model we want to adopt going forward. The Deputy used the phrase "to disentangle". In terms of disentangling this issue, there are complex funding decisions to be taken into account. There is also the matter of service delivery. So many services are delivered in this country by voluntary hospitals. There is a lot of support for voluntary hospitals. The debate certainly began on the system that was being suggested for St. Vincent's. We have come to a very clear outcome on that, and a very important outcome. It is absolutely the right outcome. In terms of the broader issue of the combination of public hospitals and voluntary hospitals that we are going to have in this country going forward, I believe there is a political discussion to be had on that. There are many different elements to it.

If the Tánaiste is accepting that point, why would she then add to the complexity by handing over a public asset to a private organisation? This is not just a question of a voluntary hospital, it is a question of two public hospitals within a private corporate entity. In the case of the children's hospital, which will be on the grounds of St. James's, nobody suggested for a moment that St. James's should own it. Does anybody in Government actually know what the financial status is of the different elements of the St. Vincent's Healthcare Group? Can the Tánaiste clarify the status of the Mulvey report? Can she guarantee that public money will only be used in the public interest and that the Government will ensure that the public purse is protected by ensuring that the new national maternity hospital will remain in public ownership? That is a key point. It would be most unwise on financial grounds for the Government to contemplate doing anything else.

I believe is very important that this project gets built without the delay. I am sure the Deputy is familiar with the circumstances in which care is being delivered to pregnant women in Holles Street at present. Staff do an amazing job but there are very poor conditions. Now that this issue of the role of the Sisters of Charity has been resolved, I believe the priority is to get this hospital built.

What about ownership issue?

Many negotiations have taken place to ensure that we can arrive at that point. The Minister is still considering some of the outstanding issues the Deputy has raised. Of course, public money will only be used to ensure a quality health care service. That is very clear from the arrangements that have been made for the transition. The transition is to a body that has a charitable status. That is the reality of the situation. It is St. Vincent's charitable status. It is not anything else. It is to ensure that health care is delivered to the public and that the highest standards are met for pregnant women and for women who need maternity and obstetric services. I believe it is important that we move ahead. I do acknowledge that the Deputy is making a broader point but with regard to the particular circumstances, a huge amount of work has been done in order to allow this hospital to go ahead at this site now.