Enda Kenny (Mayo, Fine Gael)
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Bhí mé ag éisteacht le Clare FM agus chuala mé gur inniu lá breithe an Cheann Comhairle. Ba mhaith liom mo chomhghairdeas a ghabháil leat, a Cheann Comhairle, os rud é go bhfuil tú sa Chathaoir mhór chumhachtach chompordach sin.

I wish to ask the Taoiseach a question about an issue I consider is really important in the context of our future. In interviews the Taoiseach has given in recent weeks he has quite rightly spoken of that future and of the requirement to invest in it with particular relevance to information technology, research and development. When he has been questioned he has replied consistently in the context of the National Development Plan 2007-2013 which, in his own words, is to transform Ireland and provide a better quality of life for all our people, young and old.

In that context I ask the Taoiseach about the commitment in that national development plan, on page 199, which deals with an investment of €252 million in information and computer technology for schools. This is a mess. There is less than one computer for every ten pupils and less than one in five is actually working. There is inconsistency in terms of the replacement of hardware. Broadband is not available in a number of schools. The situation, as far as the future is concerned which the Taoiseach has pointed out as being important, is all over the place. Will the commitment in the national development plan to invest €252 million over the next seven years be delivered in full and spent in full?

Brian Cowen (Laois-Offaly, Fianna Fail)
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That will depend on the budgetary parameters as we go through the next seven years. With respect, the assumptions which are set out in the plan are predicated on growth of more than 4.5% per annum. I have been making the point, generally speaking, that it is important that we prioritise investment to those areas which will improve competitiveness and ensure we continue to see investment coming to the country to create jobs and maintain and grow wealth for the country in order that we can develop public services.

Specifically, in regard to the whole question of the role information communications technology can play in the furtherance and development of our education system, at primary, second and other levels, it is important that we provide a priority for that area. As the Leader of the Opposition will be aware, that is done in the context of the Estimates process. I have heard from the Opposition, quite rightly, taking into account the change in the international environment in which we operate, the need to maintain our commitments under the Stability and Growth Pact by providing broadly balanced budgets going forward; this is an issue that has to be considered in that context.

Enda Kenny (Mayo, Fine Gael)
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This is the first admission from the Taoiseach that the national development plan is not secure and that the commitments entered into in it will no longer stand up. Last week, the Fine Gael spokesman on education, Deputy Brian Hayes, asked the newly appointed Minister for Education and Science, Deputy Batt O'Keeffe, if this money would be spent over the period of the plan. He said this was now an aspiration; following on the words of his predecessor, Deputy Hanafin, who said, in respect of class sizes and pupil teacher ratios that this was also an aspiration.

I remind the Taoiseach of what he said, as Minister for Finance, last December in his budget speech:

The national development plan is my top priority. Postponing or delaying it would be a major policy error. ... I am determined to roll it out as planned and thereby secure our future.

We are now being told by the Taoiseach that this is all predicated on prevailing financial circumstances. This will come as a complete shock and an absolute disappointment to the hundreds of thousands of pupils, teachers and parents throughout the country who will find that their schools are inadequately resourced in terms of ICT to compete with what is happening abroad and the challenges we face in the future. If it means this is no longer a commitment, where stands the national development plan? Where stands the commitment to metro north, the children's hospital etc.?

The Minister for Justice, Equality and Law Reform has said there is not a red cent in the coffers to build a hospital in the north east. If the Taoiseach is saying that the national development plan does not stand up in terms of commitments, will he prioritise what he has said that for young people the future lies in what is between their ears and what we can give them in terms of that information resource and technology? The commitment to invest €252 million over seven years is an investment in the future. As Taoiseach, whose foreword — Transforming Ireland, A Better Quality of Life — is in this plan, will he give a commitment that at least this element of the national development plan will be honoured in full as he said last December when he delivered his Budget Statement as Minister for Finace? The future jobs, the future economic expansion of this country, the future careers of thousands of young people currently in primary school and starting secondary school depend on his answer.

Brian Cowen (Laois-Offaly, Fianna Fail)
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The commitment of the Government to education has been unprecedented and will continue. As I have said, the commitment I hear from the Opposition depends on the day of the week and what spokesman I listen to. On the one hand, it speaks about the deterioration of the public finances and then says we are not spending a sufficient amount, as the Leader of the Opposition said today.

Bernard Allen (Cork North Central, Fine Gael)
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What has the Taoiseach to say?

Brian Cowen (Laois-Offaly, Fianna Fail)
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The finance spokesperson will come in tomorrow and say that I am increasing spending at three times the rate of what it should be.

John O'Donoghue (Kerry South, Ceann Comhairle)
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The Taoiseach without interruption.

Brian Cowen (Laois-Offaly, Fianna Fail)
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I am just pointing out the factual position from the Leader of the Opposition's point of view. In regard to what I am going to do and what this Government will do, we will prioritise investments in those areas which will be most productive for the economy and for society. Education has been an area where, since this Government took office in 1997, we have consistently expanded and increased investment on an ongoing basis and will continue to do so. We will have to do so as members of the euro area in compliance with Stability and Growth Pact commitments which affect all governments. That requires us to keep a broad budgetary balance which is an issue on which the Opposition spokesman on finance has been speaking.

In regard to the specific issue raised by the Deputy, an expert group was set up by our previous Minister for Education and Science, which reported at the beginning of the year on the expenditure on the hardware, software, technical support and teacher training. Implementation of the plan is being considered.

Brian Hayes (Dublin South West, Fine Gael)
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The report has not been published.

Brian Cowen (Laois-Offaly, Fianna Fail)
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I am making the broader point, one which will affect whoever is in government in the years ahead, that we have to take cognisance of the international economic environment from which we cannot be immune. We have certain commitments with which we have to contend and in the meantime we will prioritise investments in the productive sectors of the economy, including education, physical infrastructure, social expenditure and other areas, on the basis that, year on year as our Estimates are being prepared, we come forward with proposals which give priority to those areas. That is what we will do.

Brian Hayes (Dublin South West, Fine Gael)
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Will the Government publish the expert group's report?

John O'Donoghue (Kerry South, Ceann Comhairle)
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The only Members with standing during Leaders' Questions are party leaders.

Brian Hayes (Dublin South West, Fine Gael)
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And the Ceann Comhairle.

John O'Donoghue (Kerry South, Ceann Comhairle)
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That goes without saying.

Eamon Gilmore (Dún Laoghaire, Labour)
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It is now virtually impossible to pick up a newspaper or listen to a news bulletin without learning of a further crisis in the health service. Last week, we had the story of failures in X-ray services in the north east. Last Monday night, a "Prime Time Investigates" programme showed the dilapidation of our health service, including the case of an elderly woman trying to cope with caring for her husband, a stroke victim, without a home help. Medical experts are warning of a diabetes epidemic and we have the continuing trend towards the privatisation of the health service.

Today we learn that 100 jobs are to be cut in Our Lady's Hospital for Sick Children in Crumlin. I understand those affected are mainly agency and temporary workers who have been taken on by the hospital because the recruitment embargo prevented it from recruiting in the normal manner. We are told, by way of a circular issued by the hospital yesterday, that 100 staff will be removed from the hospital because the Health Service Executive has given it €14 million less than its projected expenditure this year. One cannot take 100 staff out of a hospital without affecting patient services. This measure will inevitably result in sick children not getting the treatment they need in the hospital and parents of sick children being told their child will have to wait because the hospital is unable to provide the services it should provide.

All the crises in the health service come back to the failure of the HSE, the instrument established by the Government to run the health services, to manage the health service properly. I have two questions for the Taoiseach. First, what will be done to ensure Crumlin hospital has the staff it requires to treat the sick children who present for treatment and to assure the House that in different economic circumstances, cuts in expenditure will not be made in areas which affect the most vulnerable, among whom are children who are ill and need treatment? Second, will the Taoiseach take up the proposals developed by the Labour Party's spokesperson on health, Deputy Jan O'Sullivan, and published by my party last week for the reform of the health service and, in particular, the HSE? It is manifestly clear the HSE is not managing and running the health service to deliver the quality of care required.

Brian Cowen (Laois-Offaly, Fianna Fail)
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I remind the Deputy he was a member of a Government which unanimously agreed that, based on bitter experience in the past, the best way of trying to develop the health services was to introduce service planning. On the basis of allocations provided to hospitals, service plans would be drawn up and adhered to in the interests of maintaining a level of service that had been provided on an ongoing basis and building incrementally, year on year thereafter, in the event of further investment being made in the health service. This was unanimously agreed at the time and I was the first Minister for Health to introduce and live by those disciplines.

On the particular issue which has arisen in Crumlin hospital, the problem in relation to service planning is that there was an overspend of €10 million last year and the projected overspend, on an increase in the allocation from €128 million in 2007 to €137 million this year and an increase in the hospital's budget of almost 40% over the past four years, is of a further €14 million beyond the €137 million figure. What is being said and must be accepted by all of us is that if we are to have planned and sustainable improvements in the health service, quite apart from the reforms being put forward by the HSE to build greater community care services in order that services are not all taken up at the acute hospital end, we also have to maintain the reforms introduced by previous Governments, including the one of which the Deputy was a member. Service plans have to be adhered to in the interests of developing services in the short and longer term.

The Opposition now appears to suggest that we can develop a health service based on the demand led system of budgets regardless of what budgets are allocated to which hospitals. The idea that this approach rather than trying to adhere to the budgetary disciplines required would not create even greater dislocation or more problems escapes me. That is the position in relation to Crumlin hospital.

What is being required is that we try to live within existing allocations. Owing to the good work Crumlin hospital has been doing and its important work nationally, an agreement was made to deal on a once off basis with last year's overrun of €10 million and provide a further €7 million in respect of a projected overrun of €14 million this year, while requiring the hospital to work within its budget which will be amended from €137 million to €144 million this year based on an allocation of €128 million last year. That is what is being required of the hospital and consultation is ongoing between management and representatives to determine how to meet this requirement.

Pádraic McCormack (Galway West, Fine Gael)
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That is what they spend their time doing.

Brian Cowen (Laois-Offaly, Fianna Fail)
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Some 70% of the hospital's costs are staff related. The employment of temporary and agency workers cannot continue on an ongoing basis. No permanent positions are being cut or anything like that. The hospital must be managed within its allocation. Otherwise, as the Deputy knows, under the law introduced under the Administration of which he was a member and with which I agree and supported at the time, the overrun will become a first charge on the allocation for the following year, which places even greater pressure on the hospital's ability to maintain the agreed level of service. We all agreed on this approach in the interests of trying to provide a means by which we have some sense of budgetary and management discipline in delivery of the health service.

Eamon Gilmore (Dún Laoghaire, Labour)
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If one takes 100 people who are working in a hospital out of it, one will affect the service the hospital provides.

Joe Costello (Dublin Central, Labour)
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That is the point.

Eamon Gilmore (Dún Laoghaire, Labour)
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When parents show up in Crumlin hospital with a sick child, they will not want to hear about service planning, budgetary discipline, the millions of euro allocated in this or that year or which Administration introduced what legislation. They will want to have their child attended to and cared for. If there are 100 fewer staff in the hospital, this will be less likely and it will be more likely they will be told to go away and wait. The job of the Taoiseach, Government and HSE, the body the Government set up to run the health service properly, is to have this problem fixed and the issues of service planning, budgetary planning and so on sorted out because patients, the people suffering at the receiving end of a health service that is not working, do not want to hear these excuses. They want to get better, be cured and secure the services they need in our hospitals. The problem is that the body the Government set up to run the health service is not doing its job efficiently.

Last week, the Labour Party published a set of proposals on the reforms required in the HSE to put right this problem, including a proposal to introduce a voluntary scheme to remove from the Health Service Executive the overlapping layers of management, administration and bureaucracy which appear to be getting in the way and eating budgets which should be used to provide the staff required at the front line to deliver the service in hospitals and health centres. We are long past the stage of arguing about budgetary discipline, service planning and all this gobbledegook——

Brian Cowen (Laois-Offaly, Fianna Fail)
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It is not gobbledegook.

Eamon Gilmore (Dún Laoghaire, Labour)
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It is gobbledegook to patients. It is gobbledegook to a parent who comes into a hospital with a sick child but is told that the child cannot receive any service. The Taoiseach must sort this out and reform the HSE so that we do not end up in a situation where different hospitals or services are not functioning from one week to the next. It is long past time to sort out the mess in the health service, reform the HSE and provide the care to patients for which taxpayers are paying.

Brian Cowen (Laois-Offaly, Fianna Fail)
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That is the beauty of being in Opposition. You can have it every way.

Brian Cowen (Laois-Offaly, Fianna Fail)
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Let me answer the question.

Dinny McGinley (Donegal South West, Fine Gael)
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We all remember the Taoiseach when he was in the Opposition.

Brian Cowen (Laois-Offaly, Fianna Fail)
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It is a comfortable position.

Dinny McGinley (Donegal South West, Fine Gael)
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He hounded the Government day and night. He cannot take his medicine.

Brian Cowen (Laois-Offaly, Fianna Fail)
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I would like to answer the question.

John O'Donoghue (Kerry South, Ceann Comhairle)
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This is Leaders' Questions. The only people allowed to speak are the party leaders and the Taoiseach. I ask the Taoiseach to address his remarks through the Chair. It would help.

Brian Cowen (Laois-Offaly, Fianna Fail)
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If the contention is that we can improve the health service without any reference to the budgets that are allocated, then I fundamentally disagree.

Brian Cowen (Laois-Offaly, Fianna Fail)
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If that is not the position of the Opposition——

Alan Shatter (Dublin South, Fine Gael)
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After 11 years in Government, is the Taoiseach responsible for anything?

Dinny McGinley (Donegal South West, Fine Gael)
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Will he admit that he was over here at all?

Brian Cowen (Laois-Offaly, Fianna Fail)
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I listened in silence to what Deputy Gilmore had to say and I would like to respond to him. If his position is not that the health service can be developed without reference to budgets, then we must live within those budgets; otherwise, we cannot develop the health service. People who come into hospitals with serious cases will of course be dealt with.

Dinny McGinley (Donegal South West, Fine Gael)
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They are not dealt with.

Brian Cowen (Laois-Offaly, Fianna Fail)
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The issue is that they will be dealt with through the increased allocations being provided. If the position of the Opposition is that once the allocation is made, it does not matter as long as it is sorted out, then things cannot be done that way. Members of the Opposition know it cannot be done that way because it was not done that way when they were in Government.

The second part of the question related to the idea that these reforms will sort out the problem——

Paul Kehoe (Wexford, Fine Gael)
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Call a meeting. Bring them in.

Brian Cowen (Laois-Offaly, Fianna Fail)
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There has been much involvement in the past by local representatives at health board level, but that did not solve the problem. The problem can be solved by supporting the reforms that we are trying to bring about, which will ensure that we have greater investment in community care. We cannot have a situation where the acute hospital sector takes up all the allocation to the extent that it is currently doing. We must reform the health service, as Professor Drumm said yesterday in the interview he gave in response to this programme.

Joe Costello (Dublin Central, Labour)
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That will be a long time.

Brian Cowen (Laois-Offaly, Fianna Fail)
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It will not be a long time, because what is involved is——

James Bannon (Longford-Westmeath, Fine Gael)
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After 12 years the health service is a shambles.

Brian Cowen (Laois-Offaly, Fianna Fail)
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People can come in here and continue to argue for the status quo. However, the status quo will not solve the problem. If the suggestion from Deputy Gilmore is that nobody wants to hear about the budgetary situation, then I am sure that is true. However, if one is in the job, then one must work within those budgets. If the Deputy was in my position, he would have to do the same. The only way we can solve that problem is by working with those who are trying to implement the reforms on the basis of increased allocations.

Resources are being increased significantly. An extra €5 billion has gone into the health service in the past four years, yet perennial problems arise and we are trying to deal with them. The only way we can do that is for everybody to change the structures by which the system is being delivered. That is the truth of it. The Health Service Executive is involved in making those changes.

Michael D Higgins (Galway West, Labour)
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It is doing this by cutting home help service.

Brian Cowen (Laois-Offaly, Fianna Fail)
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No, it is not. There are 63,000 more families receiving home help than when Deputy Higgins was in Government.

Brian Cowen (Laois-Offaly, Fianna Fail)
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There are 10,000 home help packages that were not available a few years ago. Reforms are being implemented and primary care is a critical part of those reforms. The amendment of the consultants' contracts, by bringing them into clinical directorates in hospitals, and the management of services in our hospitals are an important part of that.

The fundamental point is that allocations have been increased and there has been no cutback in the amount of money being provided. When we make the allocation, we must ensure that the service plans work to those allocations. Otherwise, as the Deputy knows — this is not gobbledegook — the legal position is that this will be a first charge on whatever goes in next year. That will greatly undermine the ability of the staff and the management who are working hard to provide the level of service that is currently being provided.

Alan Shatter (Dublin South, Fine Gael)
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It is just a bigger bureaucracy.

Brian Cowen (Laois-Offaly, Fianna Fail)
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Deputy Gilmore and I both know that is the case. We must start from the reality that there are finite budgets, however much they are increased, and we hope to increase them again in the future. The amount of resources going into the health service in the past five to six years is unprecedented. As Professor Drumm said, we must ally resource allocation with reform in the delivery of the service. Otherwise, we will continue to have the sort of debates we have been having until now, with no prospect of a solution.

Bernard Durkan (Kildare North, Fine Gael)
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A total of 34,000 extra administrative staff have been employed in the HSE.