I welcome this opportunity to give an account to the Dáil of my actions in April 2019 in relation to the contract negotiated between the Government and general practitioners, GPs, represented by the Irish Medical Organisation, IMO. I welcome the opportunity to set the record straight, to refute some of the allegations against me and to apologise for my errors of judgment.
I want to share with the House my motivations throughout this. I am a doctor by training and a qualified general practitioner. So is my father. I grew up over the shop which was his surgery in Blanchardstown. I believe the solution to many of the shortcomings in our health service lies in developing primary care and community care. At the heart of this are general practitioners, hard-working, committed, dedicated people, rooted in their community, who already provide high quality, easily accessible medical care with no waiting lists, 24-7, 365 days a year. They are willing to do more and all that they ask is that they are properly resourced and supported and it is the role of the Government to enable this. For most of the last decade, as a consequence of the financial crisis, we were forced to do the opposite and resources were taken away from general practice and community care. This had a detrimental impact on our health service as a whole and led to many newly-qualified GPs, including many I knew personally, losing heart and deciding to emigrate.
Only from 2016 onwards did it become possible to change this. As Minister for Health, alongside the then Minister of State, Kathleen Lynch, I was able to secure agreement on a new contract with GPs to manage diabetes in the community rather than in hospitals. It was a major step forward that has improved care for tens of thousands of patients. We also made implanted contraceptive devices, first-line investigations such as 24 hour blood pressure monitors and other services more available than before.
This was just a prelude of what could be achieved through a wider contract, if we had had the budget to do so.
We also negotiated a new contract with the IMO to extend free GP care to all children under six years old and all seniors over 70 years old. While the latter was well received, free GP care for children under six years of age was not. It was controversial and caused division among GPs and the medical community. It was broadly supported by the IMO which represents all doctors, including GPs, but not by another organisation representing GPs only, the National Association of General Practitioners, NAGP, which actively campaigned against it. Rivalry between the organisations was often bitter; it made agreement harder to achieve and held back progress. The NAGP wanted to be at the table. Some GPs were members of both organisations and some were members of neither. Ultimately, the Government decided to deal with the IMO alone, as its long-standing negotiating partner and Irish Congress of Trade Unions, ICTU, affiliate. The Opposition was very critical of this at the time.
We committed, however, to keep the NAGP engaged, involved and informed as to the progress and outcome of negotiations. The then Minister for Health, Deputy Harris, informed the Oireachtas Joint Committee on Health in February 2019 that while negotiations were with the IMO, "there was a role for the NAGP to play in terms of being consulted and involved". In fact, in a Government memorandum at the start of the talks process in March 2018 the Cabinet was informed that there would be "formal consultation" with the NAGP. It is important to understand that general practitioners are not employees. They are contractors and self-employed, and have an individual entitlement to accept or reject any contract, regardless of any ballot. Any agreement made by their representatives is not a collective agreement in the normal sense. In fact, such negotiations are more correctly termed consultations. Each GP has to be convinced individually to sign up.
In 2015, the campaign led by the NAGP against the Government-backed contract for children under six years old was very disruptive and resulted in the service not being available universally across the country for some time. I wanted to avoid a repeat of that in 2019. When I became Taoiseach in 2017, I said that I had unfinished business in health. I meant it, and I still mean it. Among my priorities was to finish off some of the work I had left in the Department of Health. I wanted to use the influence of the Taoiseach's office to secure a new contract with GPs and to reverse the Financial Emergency Measures in the Public Interest, FEMPI, Act cuts in return for a commitment to provide new and better services in the community for more patients free at the point of use. It would be a big step forward towards achieving universal healthcare in Ireland, which I believe in, and while we might disagree on the model, almost every Member of the House agrees on that too. It would also make general practice financially viable again.
As Taoiseach, I was fortunate to have an active and energetic Minister for Health in Deputy Harris, who shared that vision, and a Minister for Finance and for Public Expenditure and Reform, Deputy Donohoe, who knew this was a political priority for me and was willing to find the funding to make it possible, even if his officials would have preferred otherwise. I took an active and personal interest in the talks, was frustrated at times when they were not progressing quickly enough and kept in personal contact with a number of GPs whom I felt were opinion leaders during all this. I was determined to get the deal done and ensure it secured universal acceptance across the GP community. I wanted to get it implemented and then move on to the next items on the agenda, such as GP care for children under 12 years old as well as further services being moved from the hospital system to the community, for example, minor surgery and antenatal maternity care. This was my sole motivation all along. I wanted what was best for general practice, patients and the public. The suggestion that in any of my actions I had anything to gain personally in any way is false, without foundation and deeply offensive.
The facts are as follows. Following lengthy negotiations, an agreement was reached on 3 April 2019 and in the words of RTÉ health editor, Fergal Bowers, the "fine details" were publicly announced on Friday, 5 April 2019, by the IMO. The details of it were extensively described in a press release issued on that day. There was also a five-page document issued by the IMO, entitled "Summary Information". This set out the financial details as well as anything that could be considered commercially sensitive - €120 million extra in fees, a 10% pension contribution increase, enhanced maternity and paternity leave, €80 million for chronic disease management and a detailed revised fee schedule. The IMO had struck a very good deal for its members and publicised that fact. I am placing this document on the record of the House this evening. The following are the words of Dr. Padraig McGarry, chairman of the IMO GP committee, on 5 April 2019:
The Irish Medical Organisation (IMO) has announced details of a negotiated agreement with Government which secures €210 million in increased funding for General Practice over the coming years. This is an important step towards investing in General Practice and valuing it as a vital part of the health service. It will do two things: restore the draconian cuts imposed on GPs and bring new and much needed funding to deliver new services to patients in the community.
I am also placing the following full statement on the record of to the House. On Saturday, 6 April 2019 the HSE issued a statement entitled: "GP Contract Launch". "Launch" was the term used by the HSE. Anne O’Connor, interim director general, publicly welcomed the agreement on GP contractual reforms. I am putting her statement on the record of the House as well. In addition, at a public event in a primary care centre on the Navan Road on the same day the agreement was welcomed and endorsed by me, as Taoiseach, and the Minister for Health. I am placing that statement on the record of the House.
On Tuesday, 9 April, a memorandum was brought to Cabinet by the Minister for Health informing the Cabinet that "engagement had concluded" with the IMO. The matter did not return to Cabinet as no significant changes were made between then and its formal publication on 17 May, although there were minor ones. The fact is that an agreement had been reached and the nature of that agreement was not something that was an official secret, highly confidential or commercially sensitive after 6 April. On the contrary, all the salient information was in the public domain and was being discussed at public meetings that GPs were attending. There were calls in the Dáil at the time for the full text of the agreement to be published. Deputy Louise O’Reilly said: "we should have had it the day after it was agreed by the IMO". Deputies Alan Kelly, Stephen Donnelly and Róisín Shortall were all critical of the fact that it had been agreed but not published in full. Another Deputy mentioned the possibility that GPs who were members of the IMO might see it before those who were not and pointed out that some GPs who were not members of either organisation might be at an unfair disadvantage.
In the normal course of events, agreements are published within days if not on the night they are made. As the Taoiseach said the other day, on reflection it would have been better if that practice had been followed here. I fully respect, however, that the IMO wanted to do it differently and wanted to hold meetings around the country to consult and engage with its members before doing so. For my part, as Taoiseach and in my capacity as Head of Government, I was keen that the agreement should be well received by the general practitioner community as a whole and not just those who were members of the IMO. It was a good deal and I wanted it to be universally accepted. In particular, I wanted to avoid a repeat of the problems we had getting the agreement on children under six years of age implemented.
As I said earlier, GPs are not employees. They are self-employed contractors and they had an individual entitlement to accept or reject it. Indeed, there are some who are still operating on very old contracts to this day, having chosen not to accept those negotiated in recent decades. At this time, Dr. Maitiú Ó Tuathail was president of the National Association of General Practitioners. It claimed to have 1,200 GPs among its members. I posted a copy of the agreement to Dr. Ó Tuathail between 11 and 16 April 2019, most likely on 15 or 16 April. I did so on a confidential basis, believing publication was imminent anyway. I wanted his opinion on it and hoped that in seeing how favourable it was, it would remove or mollify any opposition from that organisation. I wanted him to see that there was nothing in the terms of the agreement that was contrary to what was publicly announced and that there was nothing in it worth opposing or agitating against.
In the end, the deal made by the IMO was demonstrably good for general practice. The NAGP did not oppose it and, in any case, the organisation fell into decline very soon after due to internal issues. Providing it with the information did not confer any advantage over the IMO on anyone else. Indeed, arguably, anyone affected by it should have been given access to it as soon as agreement was reached or shortly thereafter. This is the normal practice. The Government had publicly committed on multiple occasions to keep the NAGP informed as to the progress and outcome of negotiations. Indeed, the Opposition went further and argued that we should have included it in the talks from the start. In providing a copy of the agreed and publicly announced terms of the agreement, I was honouring a political commitment made by the Government which I led, including commitments given here in the Dáil. The agreement having been made, the question at that point was different - how to get GPs to sign up to it quickly and en masse. This was my objective.
It has been alleged that there was something improper, perhaps even criminal, in my connection with Dr. Maitiú Ó Tuathail. This is not the case. It has been reported that he is "a Varadkar cheerleader".
Yes, there are many examples of his public support for me, but there are also plenty of the opposite. For example, on 13 April 2019, in the middle of this timeline, he publicly attacked the Government for providing more GP visit cards, calling it a shameful "vote-getting exercise". He went on to describe the policy of the Government that I led as "the biggest con job in the history of the health service". That was not exactly cheerleading. This was someone who was president of the NAGP, who I wanted to be in support of the agreement and not vehemently opposed to it, as it had been in 2015.
It will not surprise you to hear, a Cheann Comhairle, that Ministers have lots of people's numbers in their phones. Prime Ministers have each other's phone numbers and speak informally in between official meetings. Occasionally, we even exchange what are termed "non-papers". In fact, any party involved in the talks relating to Northern Ireland would be very familiar with all of this. The same goes for informal contacts between Ministers and union leaders, business leaders and indeed Deputies and Senators. There is nothing inappropriate about informal contacts of this nature per se. In fact, little would get done without them, and we all know it.
Sometimes people like to exaggerate the nature of their relationships, to inflate their own influence or to claim to speak for a person when they do not - to claim to have greater access than they really have. Friends, acquaintances and supporters may claim to be closer than they really are. This is clearly a big part of this story. If we are honest, most of us in this House are familiar with that phenomenon too. I am always willing to help people, those whom I know and those whom I do not know, just as I am willing to help a constituent in need, but I never do so in a way that confers on them any sort of special treatment or advantage. This is never something I have been accused of before.
Having said that, I do accept that the provision of the agreement by an informal communication channel to the president of the NAGP, in the way that I did, was not good practice. I regret that I did not ensure that it was provided in a more appropriately formal manner. It was an error and one I accept sole responsibility for. I know it has caused people to question my judgment, but I hope, having heard my explanation, no fair-minded person will question my motivation or integrity. I do regret it and I am sorry for the controversy and annoyance that my actions have caused, including to members of the medical profession, members of the IMO, my colleagues in government and to the House.
I know I have made mistakes as a Minister and when I was Taoiseach. I have tried to learn from them. There are things I wanted to do and failed. Even with the things we did achieve, I wonder if we could have done more. Over my career I have been guilty of errors of judgment, but I have never been motivated by a desire for selfish financial gain or motives corrupt; not for a minute. My guiding principle today is the same as it was when I entered political life. That is, to serve my country to the best of my ability, to make a difference while I have an opportunity and to reward the enormous privilege of being elected to this House by helping to improve the lives of all our citizens. I knew the new GP contract would make a difference and help some of the most vulnerable in our society who needed it the most. I made an error of judgment in trying to achieve that result, motivated by the best reasons, but there was nothing selfish or dishonest, let alone corrupt or illegal, in what I did.
I have been asked to give a full and detailed account of my actions to the Dáil. I have done so. I have been asked to set out the timelines. I have done so too. I have also been asked about the "full impact" of my actions. There was no impact, certainly no negative one. The deal was done. It was well received and was accepted almost universally by GPs. It is now a reality and is being implemented and providing better, more accessible care to more patients in the community and that is what really matters. I am happy to answers the Deputies' questions.
