Enda Kenny (Mayo, Fine Gael)
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We have grown accustomed under this Government to crisis in the health service but the withdrawal of the services of the country's most senior doctors is unprecedented and will pose a grave threat to the health of our people.

In the past week, 89% of the consultant members of the Irish Medical Organisation voted for strike action. On Sunday, at an extraordinary general meeting, the 1,600 members of the Irish Hospital Consultants Association were balloted for strike action and there is no reason to believe the result of that ballot will be anything other than an overwhelming vote for strike action.

The dispute is long-running and has been exacerbated by the actions and words of all parties involved. It is already affecting the health service in that for the past year consultants have refused to co-operate with the health reform process of which they are a vital part. Other than a few organisational name changes in the past month, the health system remains stalled. The chronic problems of the health service remain unaddressed and the crisis in accident and emergency units around the county continues to reach even more dramatic proportions on a daily basis.

Does the Taoiseach agree that while the three parties involved in this dispute, the Government, the consultants and the Medical Defence Union, will be affected to varying degrees by the consultants' strike action, the major losers in any such process will be the patients for whom the Government and the consultants have a duty of care?

Does the Taoiseach accept that if this strike takes place and consultants withdraw their services, it will result in the cancellation of all outpatients clinics in both public and private hospitals, there will be no elective surgery admissions and the acute hospital system will effectively grind to a halt for all but the most urgent and critical patients? Will the Taoiseach update the House on the response the Government is giving this impending crisis and the action he is taking to prevent it?

Bertie Ahern (Dublin Central, Fianna Fail)
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On Friday, 4 February, the consultant members of the IMO voted by a large majority for industrial action arising from the dispute over the introduction of the clinical indemnity scheme and responsibility for historical medical malpractice claims. This was followed by the meeting of the IHCA on Sunday at which a secret ballot for industrial action was conducted, with action taking the form of the cancellation of elective procedures and outpatient clinics, with consultants only available to deal with emergency cases from mid-March.

The Department of Health and Children has been engaged in ongoing discussions with the Medical Defence Union which has, to date, refused to assist up to 25 Irish consultants and former members, predominantly obstetricians, who are facing medical negligence claims. The purpose of these discussions is to seek to negotiate an arrangement with the Medical Defence Union under which it would continue to be liable for all known obstetric malpractice cases, with the Irish Government assuming responsibility for all such cases incurred but not reported prior to 1 February last year, the date on which the clinical indemnity scheme was extended to cover claims against hospital consultants. Progress in these discussions has been extremely slow due to the reluctance of the MDU to submit to a due diligence exercise. Such an exercise is essential to satisfy the public interest requirements of Irish law and the State aid issues that are likely to arise under European Union law.

Last Friday, the MDU notified the Tánaiste and Minister for Health and Children that it was withdrawing from negotiations in response to comments made about the MDU before the Oireachtas Committee on Health and Children on the previous Wednesday. In the light of this development, the Minister will meet the Government's legal advisers this week to discuss the legal options open to her to compel the MDU to honour its obligations towards Irish consultant members and former members. That is how matters stand at the moment.

Enda Kenny (Mayo, Fine Gael)
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I thank the Taoiseach for his reply. The dispute, as the Taoiseach has pointed out, is effectively triangular. It involves three parties, each of whom is in dispute with the other. The Government is in dispute with the consultants and the Medical Defence Union. I accept that the Medical Defence Union should honour its commitments. The consultants are in dispute with the Medical Defence Union and the Government. The Government states it will provide cover and that nobody will be left off cover, and the consultants say that statement is not legally comprehensive enough. The Medical Defence Union is in dispute with the Government and the consultants. A Medical Defence Union representative yesterday stated this could be sorted out in an hour if the Minister were willing.

Nobody in this House wants this dispute. Everybody wants a solution before a crisis develops. Given that it is a three-sided dispute, no progress will be made if people keep sounding off from their respective corners, and highly qualified and eminent personalities, both here and abroad, are involved, will the Taoiseach, on the basis of legal advice and in an effort to deal with the matter, consider calling in an independent arbitrator to call all three sides together to create a situation where common sense will apply, where responsibility where it is vested will be honoured and where the end result is that the patients, who are the persons involved at the centre of all of this, will not suffer in any way because of disputes regarding legal issues of responsibility that should be owned up to by all sides?

Bertie Ahern (Dublin Central, Fianna Fail)
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There is no doubt that if all elective and emergency cover were removed, it would be patients and the general public who would suffer. The Government has endeavoured for a long time to resolve the issue and will continue to do so. However, there are legal issues that cannot be set aside.

Following the Minister's meeting with the IHCA on 2 February, a meeting between the Government's legal advisers and the legal representatives of the IHCA is being arranged for later this week to discuss the written assurances given by the Minister that no consultant would be left without cover and no patient would be left without compensation, a commitment given as a result of the actions of the MDU. The IHCA does not consider that this assurance goes far enough and seeks a legally binding commitment. However, the Government has been advised that such a commitment could undermine any subsequent legal challenge by the State against the MDU and that that possibility cannot be ignored.

I accept that Deputy Kenny is being constructive and we are trying to avoid a crisis. As I have stated, the Minister's legal advisers and the legal representatives of the IHCA are to meet in an effort to resolve the issues. The issues cannot be set aside but we will do our utmost to make progress. I discussed this matter with the Minister this morning and she is anxious to try to bring the matter to resolution. However, she cannot set aside the legal issues at stake.

Pat Rabbitte (Dublin South West, Labour)
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It is reported in the media that the Government this morning considered the latest report of the Independent Monitoring Commission. Based on what he has seen of the latest report of the IMC, has the Taoiseach any cause to review his earlier statements that the Northern Bank robbery was the work of the provisional IRA and that the leadership of the republican movement had advance knowledge of that? If it is the case that the IMC report has reinforced the Taoiseach's convictions in the matter, why are such conflicting signals coming from the Government? This was an enormous breach of trust. Surely there must be consequences for the people involved, yet conflicting signals are coming from Government. Most recently we were told that when the Taoiseach met the IMC, he encouraged it not to impose any penalties on Sinn Féin. I understand the Minister for Foreign Affairs is or will shortly be in Washington negotiating invitations for the Sinn Féin leadership to the White House St. Patrick's Day celebrations.

Given the IRA statements which were generally accepted by everybody across the board as threatening, does the Taoiseach believe these responses are appropriate? Does he not agree that the democratic parties ought to maintain a consistent position in the light of these threats? More specifically, if the IRA states that all its previous offers are now off the table, is it not entirely reasonable for the Irish Government to make clear that the release of the killers of Detective Garda Jerry McCabe are similarly off the table?

Bertie Ahern (Dublin Central, Fianna Fail)
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I hope there are no conflicting statements. Somebody handed me a newspaper this morning that I was not aware existed. It contained a number of references to me that I found interesting to the effect that I was backing off in the context of these issues. I understand the title of the newspaper is Daily Ireland.

Fergus O'Dowd (Louth, Fine Gael)
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Was it Senator Mary White who briefed them?

Bertie Ahern (Dublin Central, Fianna Fail)
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I was told she was an investor in that newspaper but she has informed she is not an investor in any newspaper.

On more serious issues, the Government has seen the IMC report and it will be published later this week. If anything, it will go beyond anything I have said on previous occasions. I will leave people to read this independent report for themselves.

On the issue of sanctions, when these matters were discussed last week and previously, it was mooted in the public domain that had the institutions been up and running, this issue would have brought them down again. That is a fact with which I have no argument. However, I was also asked whether it would be helpful — this was also the thinking of the IMC — if, when the institutions were up and running, people could be suspended from them. That would be entirely unhelpful because it means they would never be up and running. The inclusive institutions would not be up and running if people knew that the day they were up and running they would be suspended. It was in that regard that I said I would not agree with that. The issue of sanctions and exclusion, of blocking people and not engaging with people is a hopeless exercise and will not bring matters forward.

In terms of invitations, the plans for the White House are well advanced. I do not think there will be much discussion on that issue this week. It is a matter for the Americans to announce their decision but, as I understand it, they have made their decision on these matters. These issues have passed and the Americans organise the arrangements for St. Patrick's Day.

On the IRA statement, the Government's position for many years is that we do not comment on such statements, but I do not disagree with what the Deputy said, that one can read these statements as threatening and intimidatory. I shall say some more about that later at the debate this evening.

On the issue of the release of the killers of Jerry McCabe, I answered Deputy Kenny's question. As I said recently, that issue is off the table. I have heard people say in recent days that they have made great efforts to assist the peace process. I tried my best on this one, not only on the murderers of Jerry McCabe but all the other prisoners. I supported the release of several of the prisoners, including a number of people who murdered gardaí, as part of the peace process, and we released them all. We were prepared to go along with what was a demand to try to get a comprehensive agreement. It was not an offer but a demand. I do not want to argue about that, but that is off the table and I do not see it coming back on the table. I said that to Deputy Kenny and I say it again to Deputy Rabbitte.

I recommend that people closely read the statement. I understand Deputy Rabbitte raising the question of where we are trying to go, but at the same time in all these issues one can go back into the cul-de-sac. There are times when people like being in the cul-de-sac and then they all shout "wolf", "hostage", "victim", and so on, but that is not helpful. We have to try to work on from this. While all of these issues are terrible, we have to get to an end and we have to continue to work at the process. It is not a question of changing or being soft, we have to try to find a way to move on. I do not see an easy way of moving on at present. I do not see a way of getting the trust and confidence. I do not know how we will do that but I do not want to get ourselves painted into a position.

We have to mark where we are and the IMC in its report will do that. Somebody on the Deputy's side referred to confirming the confirmation, and it is beyond doubt. I will let the Deputy read the report. The Government has no position on changing the report. We made many recommendations and we accept the report. We have to try to see where we can move in the future. I am conscious, as is Deputy Rabbitte, that the marching season will come upon us and that brings its own problems and tensions, of which we must be mindful. Community leaders in Northern Ireland are asking me to be mindful of that, but it does not remove any of the issues we have debated here in recent weeks and which will be totally collaborated in the IMC report this week.

Pat Rabbitte (Dublin South West, Labour)
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Judging from what the Taoiseach has said, there is no ambiguity and no doubt about the clarity of the conclusions in the report of the Independent Monitoring Commission. I hear what the Taoiseach says about no sanctions and no penalties, but surely there must be consequences. It cannot be a case of business as usual, otherwise we will be back again in five or six months' time in a similar position. As regards exclusion and inclusion, the Labour Party agrees with the Taoiseach on an inclusive process but there is no room for threats in an inclusive process. In terms of exclusion, will care be taken on this occasion to ensure parties such as the SDLP, which was at the architectural stage of the peace process, will be included as well as the UUP, the Alliance and so on? I know the Taoiseach will say he met them but when the serious negotiations start, parties such as the SDLP which can claim more than the average share of authorship of the process will say they were excluded when the real business was being done and that what was in prospect of being signed off was, therefore, inferior.

I heard what the Taoiseach said about the release of the killers of Jerry McCabe in this new situation and I welcome that.

Bertie Ahern (Dublin Central, Fianna Fail)
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I think we all agree with the politics of inclusion. In the last round of discussions in April 2003 and October 2003 the SDLP and the UUP were working together and others were excluded. They were not totally excluded, but the key issues were the two parties. On 8 December the DUP and Sinn Féin were involved because their mandates put them in that position under the Good Friday Agreement. As regards people being excluded, it was only when we were dealing with issues that other parties had nothing to do with that they were excluded. What the Deputy said about the SDLP is correct, and without the SDLP we would not have had a Good Friday Agreement. We would probably have had nothing in Northern Ireland. Of course, the SDLP has to be kept fully involved at all times and our policy is to do that. That party does not bring anything to the table and neither would it want to in terms of decommissioning and all the other issues we were trying to deal with in putting arms beyond use.

Deputy Rabbitte asked what is the penalty. The penalty is clear. As we stand today, there is no possibility whatsoever of making progress on the peace and confidence that leads to an inclusive working executive and administration in Northern Ireland under the terms of the Good Friday Agreement unless the Sinn Féin leadership comes back to both the Irish Government and the British Government, as requested, to give us answers about the three areas on which we asked for answers, that is, paramilitarism in all its effects and particularly the issues of decommissioning and criminality. I do not think, even if we get answers, we will be able to move fast, but we certainly cannot move in the short term without those answers.

Joe Higgins (Dublin West, Socialist Party)
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Many recent reports in the media have highlighted grievous exploitation of immigrant workers. In the construction industry SIPTU officials have found such exploitation. Recently the bricklayers union, BATU, was so concerned that it met the Polish and Lithuanian ambassadors to highlight a gross abuse of their nationals. I wish to raise, in particular, one major scandal of immigrant worker exploitation of massive proportions. There is a major foreign-based multinational construction company employing approximately 10,000 people, 2,000 approximately in this State, which has secured massive local authority and State contracts here. This company imports workers from its home base, who do not speak English, controls their passports and work permits, accommodates them often in company barracks, demands an extent of hours worked that can only be called grotesque and, incredibly, pays unskilled construction workers between €2 and €3 per hour basic pay and skilled workers somewhere over €3 an hour. In short, this is a modern version of bonded labour. The instigator is Turkish-based Gama Construction Ireland Limited.

The national minimum wage is €7 an hour. The registered employment agreement for the lowest paid operative in construction is €12.96 an hour. This case is a national scandal financed by extensive public funding. I call on the Taoiseach to ask the Minister and the Department of Enterprise, Trade and Employment, as a matter of priority, to order an immediate investigation into Gama Construction and its pay and work practices. Will its records be demanded? Will the Taoiseach ensure that interviews are conducted with workers out of the way of company pressure? Will he ensure the Department sees that no worker is victimised as a result of this investigation and if Gama Construction should act to send workers home, a method used by these companies, those workers are sheltered and protected? I will ask SIPTU, to whom the company signed up some of its workers as a cover, to do so. Companies like Gama Construction not only exploit immigrant workers but undermine wages and conditions for all workers and, through crooked means, they underbid other companies who pay the full rate. This is a serious matter.

Bertie Ahern (Dublin Central, Fianna Fail)
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I reiterate that every worker is entitled to the full protection of the law. The workers referred to by the Deputy are entitled to full legislative protection. The inspectorate of the Department of Enterprise, Trade and Employment can apply the full powers and rigours of the law to inspect the records and investigate any breaches. I am aware of some other cases where trade unions have asked the Department to investigate and this has been fully carried out. The Deputy has referred to the company by name. The Minister for Enterprise, Trade and Employment is in the House and will raise the matter of inspection with his departmental officials. Legislation to deal with such cases is pending. Any information on the case will be followed up. The key point is that every worker is entitled to the full protection of the law. The minimum rate of pay has been agreed through the Labour Court and employers have an obligation under the law to pay that rate. The inspectorate implements the law and investigates any employer in breach of the law.

Joe Higgins (Dublin West, Socialist Party)
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As the Taoiseach stated, the workers have entitlements. However, these workers are vulnerable and afraid. That is why they need the security of knowing that any attempted victimisation will be resisted. I welcome the Taoiseach's undertaking that the Minister for Enterprise, Trade and Employment will take action. We will make every information available to the inspectors. There should be many more than 21 of them, by the way.

This company has done work for local authorities. It built the Ennis and Ballincollig bypasses and was proud of the fact that it completed the work six months ahead of schedule. That is easy when using a bonded labour force working eleven or 12 hours a day with two Sundays off in a month. The company can underbid because of these rates of pay.

I want the Minister to take personal charge along with the Secretary General of the Department because it is a serious allegation. This is not a fly-by-night operation from the boot of a car. This is a major company financed by major State public contracts. I will therefore keep a close eye on it. The rights of immigrant workers are paramount, as are the rights of Irish workers who are undermined by this.

Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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I advise the Deputy that it is not appropriate to name a company in the House when it is not here to defend itself.

Joe Higgins (Dublin West, Socialist Party)
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It is entirely appropriate because——

Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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No, Deputy, it is not. It is a long-standing precedent in this House.

Joe Higgins (Dublin West, Socialist Party)
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——it takes advantage of its power over vulnerable workers to exploit them. I will not allow that to happen.

Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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There can be no argument about it. The Chair has ruled.

Bertie Ahern (Dublin Central, Fianna Fail)
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I do not know if Deputy Higgins or others have made a complaint to the labour inspectorate about the particular company. The Minister will raise the matter with the inspectorate. I note the Deputy has said he will make the information available to the inspectorate and this will be helpful. I reiterate that every worker in this country is entitled to the protection of labour law. This has been enforced in many cases. Members may remember a case three years ago where the Department took firm and positive action to uphold the rights of the workers who were from one of the now member states, then an applicant country. The same examination will take place in this case.