Enda Kenny (Mayo, Fine Gael)
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I was struck by the Taoiseach's remarks earlier today in the Chamber about the difficulties that the country now faces. There is clearly a range of serious problems ahead of us, and areas need to be changed and reformed. I was in the Netherlands at the weekend with Deputy Reilly, and we walked from the train station to the hotel, minus limousines and so on. I took the opportunity to visit a substantial hospital in the city centre, as well as some primary care centres, and I met with officials dealing with the Dutch health system. What I saw was the health system that we should have for the future. Patients are seen inside ten minutes, ambulances are required by law to pick up patients inside 15 minutes, yet the per capita spend for 17 million is €3,500, as opposed to €5,000 here.

The Fine Gael Party has published its views on how the Irish health system can be transformed from being a two tier system to a universal single system that would operate effectively in the interests of every person who requires health treatment in this country. What is in operation for 17 million people could certainly work effectively for 4 million people here. We have had rows in this House about failures and inadequacies in the health system, and about the fact that it appears to be a bottomless pit. In spite of pouring in money at an enormous rate-----

Séamus Kirk (Louth, Ceann Comhairle)
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I might remind the Deputy that we have limited time on Leaders' Questions.

Enda Kenny (Mayo, Fine Gael)
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-----each year, the health service is not delivering in the way that the Taoiseach wants, nor in the way that the people require.

Is the Taoiseach prepared to consider adopting our proposition to transform the Irish health system into a single universal health system which would operate more effectively and in the interests of everybody? I will support the Taoiseach and sit down with his people to work on a strategy to change the way we deliver health systems in Ireland at much lower cost and to far greater effect. Will he consider that?

Brian Cowen (Laois-Offaly, Fianna Fail)
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The HSE has been doing much good work to make sure that money follows the patient and that resource allocation is appropriate for the needs of patients. The issue referred to by the Deputy relates to a position he outlined in recent times. We have invited him to get his plan objectively costed by the Department of Finance, but so far he has declined to do so.

Two key changes would probably be involved in the Deputy's proposal. There are differences between the organisation of the private medical insurance systems in Ireland and the Netherlands. I understand that there are approximately 17 private health insurance companies in the Netherlands, with no company having more than a 25% share of the market. There are three or four such companies in this country, with the VHI having almost 70% of the market. One of the problems with the proposal is that it might lead to private insurance companies making decisions on all hospital and GP services. They might decide which hospitals carry out which services.

There are 14 health insurance companies, as well as related subsidiaries, in the Netherlands. That is not the case here. It has also been proposed that health insurance should be compulsory. Some people who do not currently buy health insurance would be required to do so. It is obvious that not everyone gets health insurance for free. It has not been made clear who will have to pay more, and how much more they will have to pay. The proposal involves new public spending. We do not agree with the claim that the State can subsidise the entire cost of new private health insurance policies for approximately 1.3 million people with medical cards, as well as heavily subsidising the cost of including 660,000 more people in the scheme, at no cost to the Exchequer because it is not feasible. Perhaps the best means of starting a debate on future health reforms would be to get the Department of Finance to cost them in the first instance.

Enda Kenny (Mayo, Fine Gael)
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I am here to try to offer the Taoiseach and his Government help as they try to deal with a matter that causes a major crisis in the country on a regular basis. When I was in the MCH hospital in The Hague yesterday, I learned that every patient who goes into the hospital is registered on the hospital's computer system. When the number of patients in the hospital goes beyond the point at which patients cannot be seen inside ten minutes, an extra triage nurse comes on duty. It is an outstanding system, as it operates in the interests of every person. The longest period of time that passes between a person going into hospital and being sent home or being admitted is two or three hours. There is no need for hand washers in every corridor of the hospital, as there is no MRSA problem. Patients are admitted to separate units until it is determined whether they are positive for MRSA.

This is the health system we need and can have in the future. Our system should be based on the efficiencies in Holland, where there are five major health insurance companies. The Government should follow through on it because it is so effective in looking after people's health interests. I was intrigued by the Taoiseach's comment about the cost of this proposal. I was under the impression that when political parties ask the Department of Finance to cost a proposal on a political basis, it is confidential. I am not sure whether that is the case. I would like to compare what I saw yesterday with the strategy of co-location, which has been defended by the Minister for Health and Children on umpteen occasions. That strategy has not delivered a single additional bed.

James Reilly (Dublin North, Fine Gael)
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Hear, hear.

Enda Kenny (Mayo, Fine Gael)
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Some 9,000 operations on adults were cancelled by the HSE between January and June of this year. A further 1,000 operations on children were cancelled at Our Lady's Children's Hospital, Crumlin. Earlier in the year, we were told that would not happen. Some 216,000 bed days were lost last year as a result of delayed discharges, which is the equivalent of Tallaght Hospital being closed down for a full year. That is what we have got. We know about the cancellation of the cervical cancer programme. When I checked the latest figures before I came to the Chamber, I learned that 315 people are on trolleys in hospitals around the country today. There are no trolleys in wards in any of the Dutch hospitals.

I reiterate that I will support the Taoiseach in the right circumstances. I am often accused of being at loggerheads with him on everything. That is the case on most occasions. The Taoiseach wants the health system to be sorted out. It is recognised and understood that many things have gone wrong over the last 12 months under the system the Government has put into practice, which is endorsed by the Minister for Health and Children. The chief executive of the HSE has been awarded a bonus of €75,000 on foot of such incompetence. I accept that is not what the Taoiseach stands for. It is not the kind of health system he wants. As the Leader of the Opposition, I assure the Taoiseach that my party will support him if he is prepared to take on board the effective measures that can and do work in a country of 17 million people that is a two-hour flight from here. If we start now, we can have such a system here. Otherwise, a bottomless pit of taxpayers' money will continue to be pumped into an inefficient system. The Taoiseach and I know how that can change. If he is prepared to start real reform, so am I.

Brian Cowen (Laois-Offaly, Fianna Fail)
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I do not agree with the continual portrayal of the health service, for all its problems, as not providing any successes or improvements. That is clearly not the case. If one examines successive HSE yearly service plans, one will see that many of the targets set in the plans have been met and in some cases exceeded. Measures taken in areas like cancer care and the reorganisation of hospital services have been the subject of a great deal of local political controversy. Deputies on all sides of the House have to withstand the pressures and concerns that arise from such developments.

It is only fair for me to indicate to Deputy Kenny that if he makes any proposal to change the health system, as it is currently funded, he needs to have it costed. If we have a costing on it, we can discuss it. In the meantime, the Minister and her Government colleagues are interested in providing for the necessary flexibility and redeployment to facilitate best practice arrangements for better delivery of services. Triage nurses have been provided in parts of our health system. The need to try to provide for best practice across the system has been the big bugbear. We have to get people to identify what is done well. If the community care programme in the north west is working, that needs to be done with greater application throughout the country. We should aim to replicate the success of the accident and emergency services in hospitals in Kilkenny, Waterford and elsewhere. It is usually down to people's ability to organise themselves and work in teams. Staff have to be prepared to make certain adjustments so that the service provided to clients and patients is better than is presently the case. That is how we are seeking to go forward. In the case of cancer care services, for example, we have had to rationalise from a position where we had surgical units in 42 of our hospitals, none of which had the throughput necessary to meet the relevant requirements and standards on a consistent basis or to avoid many of the unfortunate incidents that have been well discussed in this House and elsewhere over recent years.

An acceptance of the need to embrace change in the health service, for the precise purposes mentioned by Deputy Kenny, should be more evident in this House. I am open to listening to a constructive debate in this House on possible improvements in our health service, on the basis that we set out the costs of the alternatives and the issues that are at stake. It is open to the Deputy to seek such a debate. I understand that the Department of Finance has not been asked to undertake a costing of the Fine Gael proposal, but if it is asked it will do it. It will be provided confidentially to that party in the first instance.

If we are to come into this House and have a constructive debate on the matter, we should set out what the costs of the various proposals might be. The possibility that it can all be done at no extra cost is not immediately obvious to us. If it is all made compulsory, the State may have to fund the premiums of everyone in the country, including people who do not have universal health insurance at present. Certain costs would be associated with that. Important issues, such as the relationship between health service providers and hospitals and the manner in which we organise our services, have to be discussed and debated. With respect to the Deputy, who seems to have had a very good trip to The Hague yesterday, we need more substance than a simple policy of replicating the Dutch system in Ireland.

Eamon Gilmore (Dún Laoghaire, Labour)
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In the past year or so, we have spent a great deal of time discussing the banks. Time and again, the Government has come into the House to ask us to stump up taxpayers' money to help out the banks. The State guarantee scheme, which was introduced in September 2008, was followed shortly afterwards by the nationalisation of Anglo Irish Bank and the €7 billion recapitalisation of some other banks. The NAMA legislation proposes to put up €54 billion in Government bonds to take the bad loans from the banks. In return for that, we were told time and again there would be big changes at the top of the banks. The guarantee scheme, for example, provided that the Minister or regulatory authority could give directions taking specified steps to restructure executive management responsibility, strengthen management capacity and improve the corporate governance of banks. Unfortunately, we have not seen much change of this kind at the top level of the banks. Bank of Ireland appointed a new chief executive but it was an internal appointment. The chief executive of AIB announced his retirement on 30 April and has not yet been replaced. Newspaper reports suggest AIB wants to make an internal appointment whereas the Government wants to make an external one. One commentator, Mr. John McManus, writing in The Irish Times this week on these circumstances, stated "the decision of AIB to face down the Government indicates that the amazing arrogance that has characterised AIB's behaviour over the past 12 months – and no doubt contributed to the mess it has found itself in – remains undiminished".

What exactly has changed, if anything, at the top level of our major banks in return for the taxpayers' largesse? Is there a stand-off between the board of AIB and the Government with regard to the appointment of a new chief executive? If so, will the Government hold its line on it?

Brian Cowen (Laois-Offaly, Fianna Fail)
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It is important to point out the NAMA legislation and the changes in banking generally are to effect orderly restructuring of the banking and financial system over time. Instead of speaking continually about stumping up money for the banking system, one should note an investment is being made by the taxpayer in a shareholding in two of our main banks and by way of having to nationalise another. We get paid for the cost of giving the guarantee and also in respect of the preference shareholding we have taken in the two main banks. That is important to point out.

With regard to the question on specific changes in specific banks, there have been changes in a number of banks. Discussions between the chairman of the board of AIB and the Minister for Finance in respect of seeking a prospective successor to Mr. Eugene Sheehy, who announced his intention to retire, are ongoing. We seek to achieve what is best for the banking system generally.

Eamon Gilmore (Dún Laoghaire, Labour)
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The Taoiseach talked about changes being made at the top of the banks. There is little or no evidence for them. Let me outline the position regarding the main covered institutions since the guarantee was introduced. All ten of the directors of AIB who were in place at the time the guarantee was made are still in place. Eleven of the 13 directors of Bank of Ireland who were in place at that time are still in place. With regard to EBS, eight out of 11 directors are still in place and, with regard to Irish Life and Permanent, six out of eight are still in place. That is with the exception of the public interest directors.

There is little or nothing changing at the top of the banking tree. All that is happening is that the State or taxpayer is being asked time and again to put up funds to keep the banks going. At the top of the banking tree, nothing significant is happening.

The Taoiseach stated discussions are ongoing between AIB and the Minister for Finance on the appointment of a chief executive. The State owns a 25% shareholding in that bank. Will there be an internal appointment, as the board of the bank wants to insist upon? Will there be an external appointment, as it would appear the Minister for Finance desires?

Which is the dog and which is the tail in the case of banks? The banks are very quick to come with their hands out seeking assistance. We are to spend much of this week and most of next week dealing with the banks' requirements in terms of the writing down of bad debt but there seems to be no significant change at the top of the banking institutions.

Brian Cowen (Laois-Offaly, Fianna Fail)
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I do not agree with the contention that there has been very little change. There are different chairmen in various banks and different chief executives in various banks and building societies. With regard to the institutions covered under the guarantee scheme, there have been a number of changes. As the Deputy stated, there was an increase in the number of public interest directors appointed by the Government, and quite rightly so, in an effort to promote public confidence and ensure stability and continuity in a way that will in turn ensure the orderly reform of the banking system. It is important that the matter be dealt with in an orderly fashion.

I do not wish to discuss any individual banking institution but it is clear, on the basis of Mr. Sheehy indicating his preparedness to retire from his position, that there has been an ongoing effort, internally and externally, to determine who the best candidate for the post would be.

In one particular bank, an internal candidate was decided upon on the basis that it was in the best interest of the bank given the candidates available or interested in taking up the position. This is an ongoing issue. As I stated, it has been dealt with regarding another bank. I would like to see us proceed in this regard as best we can and as soon as we can.