Micheál Martin (Cork South Central, Fianna Fail)
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Despite all the election promises and Government spin, many people's experience of the health service is becoming worse by the day. Dismissing the board of the Health Service Executive without putting in place an alternative has prompted inquiries as to who is in charge of the health service. Many medical card holders, particularly those with chronic illnesses, are waiting far too long for renewals. This is unacceptable and unnecessary. The HSE service plans that have been published provide details in respect of hundreds of beds being closed in acute hospitals and, critically, in community nursing units throughout the country. Dr. Ronan O'Sullivan has articulated the fact that there has been a sharp increase in the number of children who are waiting on trolleys in paediatric hospitals. Dr. O'Sullivan has also stated that the situation is worse than ever and that bed closures are the cause of this overcrowding.

Since the National Treatment Purchase Fund was subsumed into the special delivery unit, SDU, waiting lists and waiting times have increased dramatically by over 47%. This means that 11,500 people are waiting more than six months for treatment. The increase to which I refer occurred over a very short period as a result of a policy change. Almost 45,000 people are awaiting day procedures at present and some 16,000 are awaiting inpatient surgery. The National Treatment Purchase Fund had reduced waiting times in the vast majority of cases to between three to six months. It had put in place clear targets and appropriate measures and had a dramatic impact on waiting times.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Does the Deputy have a question?

Micheál Martin (Cork South Central, Fianna Fail)
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The National Treatment Purchase Fund worked. However, the moneys allocated to it have now disappeared into the big black hole of the SDU and the wider system. As a result, waiting lists have become longer. Masking the real story, rather than tackling the lists, has become the priority.

Will the Government consider reinstating the National Treatment Purchase Fund, with an exclusive focus on reducing waiting times and waiting lists for people who desperately require surgery? Will it resolve the issue relating to medical card renewals for those with chronic illnesses? Will it deal with the overcrowding in paediatric hospitals? I am sure the Taoiseach agrees that such overcrowding is unacceptable. There are clear alternatives available which would assist in resolving this problem. I am of the view that the Government should consider exempting bed closures in paediatric hospitals. Those are the three key questions I wish to put to the Taoiseach.

Enda Kenny (Mayo, Fine Gael)
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Deputy Martin has raised a range of issues which are clearly of concern to the Government. Those issues relate to the structure of the health service and also to the way in which services are delivered to patients, either those in hospital or those who are unfortunate enough to be on waiting lists. I listened to a radio interview this morning with a paediatric professional from Our Lady's Children's Hospital, Crumlin. The individual in question made a very reasonable case and pointed out that what has happened in respect of adult waiting lists began in a small way and then just grew to unacceptable proportions. He made a very reasonable point to the effect that we should consider and deal with waiting lists relating to children. He also highlighted the fact that it is easier to deal with short-term illnesses, be they respiratory infections or whatever, that children contract than it is to deal with those which affect adults. The point he made is one which the special delivery unit and the Minister for Health will be anxious to examine. The proposition the individual in question put forward in the context of attempting to deal with this matter before it grows in the same way that the problem relating to adult waiting lists did should be given due consideration.

As Deputy Martin is aware, paediatric hospitals work together and take a unified approach. Children are obliged to await admission in personal cubicles or isolation rooms in circumstances where beds are not yet available. Those children who are admitted have access to the full range of specialist care when they are in emergency departments. I understand that the three Dublin hospitals work very closely together in order that children can, where necessary, be admitted very quickly. The hospitals have a single approach to bed capacity and a joint escalation plan is also in place. I also understand that the HSE's regional director of operations and its clinical director, Dr. Costigan, is covering the three hospitals and is arranging to meet representatives of the Irish Association of Emergency Medicine as soon as possible. The HSE has already started the roll-out of national paediatric clinical programmes under the lead of Professor Nicholson.

Deputy Martin referred to medical cards. I understand that matters in this regard have been alleviated to an extent in that medical cards will continue to be valid until people's applications have been dealt with, one way or the other. I have asked Deputies to highlight individual cases and I intend to visit the medical card section. The process relating to medical cards should not be operating in the way it is at present. I must stress, however, that in many cases the information submitted may not be clear or may be insufficient. The personnel who work in the medical card section are more than anxious to have the process streamlined in order that they can operate in a professional and very efficient manner. I hope we will be able to reach that point quite quickly.

The special delivery unit established by the Minister for Health is specifically focused on ensuring competency and reducing waiting lists and trolley times. It is also focused on dealing with cases where people have been waiting for over 12 months. I read reports in some newspapers in respect of people waiting four years for procedures relating to varicose veins and two years for orthopaedic assessment. I do not have evidence of this. Like the Minister, I would welcome details regarding the cases that are being highlighted in order that action might be taken in respect of them.

Micheál Martin (Cork South Central, Fianna Fail)
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The Taoiseach did not answer my question on waiting times. The 12 month period was a reinvention by the Minister to cover the fact that the international target of six months was the target set for the National Treatment Purchase Fund and that the vast majority of categories had come within the period of three to six months under its stewardship. What has happened is a con job. The €85 million allocated to the National Treatment Purchase Fund has been subsumed by the special delivery unit which uses it for a variety of purposes. We have gone back to the days when there were perverse incentives and hospitals that did not deliver efficiently and on time were rewarded. The National Treatment Purchase Fund had clear measurable targets and was achieving clear results. Will the Taoiseach reinstate it with its exclusive focus on waiting times because this would mean a better experience for those on surgical waiting lists? That is the key point.

With regard to medical cards, it is not good enough that the Taoiseach will visit the unit to gain a photographic experience. The bottom line is-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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The Deputy is over time. Will he, please, put a question?

Micheál Martin (Cork South Central, Fianna Fail)
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Last week I raised a number of issues. The Taoiseach's office got back to me on a particular case, which I acknowledge. However, it should not have to come to this. As soon as one case was referred to the Taoiseach, I was made aware of another of people having to wait too long and getting bad results from the centre.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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We are over time. I ask the Deputy to put his final question.

Micheál Martin (Cork South Central, Fianna Fail)
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This needs to be sorted out. This morning a consultant was speaking about emergency medicine in paediatric care, not waiting times. The issue of emergency medicine needs to be sorted out through dealing with a bed capacity issue in paediatric hospitals. It can and should be done immediately.

Enda Kenny (Mayo, Fine Gael)
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If it is of interest to the Deputy, I have no intention of announcing when I plan to visit the medical card unit. I am not interested in that type of operation. What I am interested in is ensuring people throughout the country who lodge applications for a medical card or to have one renewed will be dealt with swiftly, efficiently and professionally.

Mattie McGrath (Tipperary South, Independent)
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That is not happening.

Joan Collins (Dublin South Central, People Before Profit Alliance)
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No.

Enda Kenny (Mayo, Fine Gael)
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There have been teething problems. I have received representations from many of my own Deputies. The problem became acute when an application received was deemed to be incomplete and sent back to seek further information. A response to such an application might not have been received for a long time.

Micheál Martin (Cork South Central, Fianna Fail)
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We are speaking about 75 year olds who generally are entitled to have their medical card automatically renewed. In one case the waiting period was four months.

Enda Kenny (Mayo, Fine Gael)
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I understand changes have been made after applications have been received to continue medical card coverage until they are dealt with. Therefore, there should not be a situation where, as the Deputy pointed out, people fear they will not receive their medicines because their medical card have not been renewed. I hope this issue is being sorted out by the personnel working in the unit.

Barry Cowen (Laois-Offaly, Fianna Fail)
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Medical expenses should be reimbursed.

Enda Kenny (Mayo, Fine Gael)
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I have pointed out that the clinical director, Dr. Costigan, will meet the three hospitals and the association of emergency medicine paediatric physicians shortly to deal with the question of escalation in the provision of emergency treatment for children. The hospitals in Dublin have a joint operation in cases where escalation might occur.

The Deputy mentioned patients on trollies and waiting times.

Micheál Martin (Cork South Central, Fianna Fail)
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The National Treatment Purchase Fund.

Enda Kenny (Mayo, Fine Gael)
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I have been in many accident and emergency units during the years.

Noel Grealish (Galway West, Independent)
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The Taoiseach closed down a few.

Enda Kenny (Mayo, Fine Gael)
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It is terrible for patients who, in some circumstances, can be on a trolley for a considerable amount of time. However, it is nothing new. Deputy Martin made the comment way back when he was Minister for Health about ending waiting lists permanently. The number of adults waiting for more than six months rose between the end of 2010 and June 2011 which reflected the difficulties experienced in the health system.

Micheál Martin (Cork South Central, Fianna Fail)
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The Government has undermined the National Treatment Purchase Fund. That is what has happened. The fund is being buried by the Government.

Enda Kenny (Mayo, Fine Gael)
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The total number waiting at the end of June was 11,200 and at the end of August,12,000. Between August and December the number decreased to 11,688, a drop of just over 5% in four months. It is obvious the special delivery unit began to make an impact on waiting times.

Micheál Martin (Cork South Central, Fianna Fail)
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The number has increased by 47%.

Enda Kenny (Mayo, Fine Gael)
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The unit was established in June in order that the issue of waiting periods could be dealt with. The Minister introduced strict chronological management of inpatient waiting lists and set a maximum waiting time for treatment of 12 months-----

Micheál Martin (Cork South Central, Fianna Fail)
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That was never the target; it was six months.

Enda Kenny (Mayo, Fine Gael)
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-----to be overseen by the special delivery unit and the National Treatment Purchase Fund.

Micheál Martin (Cork South Central, Fianna Fail)
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The number waiting for six months has increased by 11,000.

Enda Kenny (Mayo, Fine Gael)
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This is working very effectively.

Micheál Martin (Cork South Central, Fianna Fail)
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It is a con job.

Jerry Buttimer (Cork South Central, Fine Gael)
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The con job is by you.

Micheál Martin (Cork South Central, Fianna Fail)
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Look at the figures.

Alan Shatter (Dublin South, Fine Gael)
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What did the Deputy do for 14 years?

Micheál Martin (Cork South Central, Fianna Fail)
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Actually, I did an awful lot.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I call Deputy Adams and ask Deputies and Ministers to please respect the Chair.

Gerry Adams (Louth, Sinn Fein)
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The Minister for Public Expenditure and Reform, Deputy Howlin, is in another building announcing the sale of State assets to the tune of €3 billion.

Barry Cowen (Laois-Offaly, Fianna Fail)
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They do not do fanfare.

Gerry Adams (Louth, Sinn Fein)
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As the person who has the privilege of leading the Sinn Féin Party as part of the Opposition, I must depend on someone else to send me a text to tell about this.

Mattie McGrath (Tipperary South, Independent)
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Any tweets?

Gerry Adams (Louth, Sinn Fein)
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Is this not a matter that should have been discussed in the Chamber? The Government is selling off successful self-financing commercial State companies such as Bord Gais and the ESB. Instead of flogging off the State's assets to earn a quick buck, it should make commercial State companies part of the solution in creating jobs and generating growth. Both Government parties - bad enough Fine Gael but mór mo náire le Páirtí an Lucht Oibre - have stated the troika is making them do it. Sinn Féin has met the troika and its members have told us that while they believe in privatisation, they do not assert - they state it is a matter for the Government - that the memorandum of understanding binds the Labour Party and Fine Gael to following this course of action. It is the Government's decision and well may the Minister for Communications, Energy and Natural Resources smile. He is the Labour Party Minister who will give away what is left of our assets.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I ask the Deputy to put a question.

Gerry Adams (Louth, Sinn Fein)
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Will the Taoiseach give us details of what has been announced outside by one of the Labour Party Ministers?

Enda Kenny (Mayo, Fine Gael)
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The Government made a decision on this matter yesterday. It was made public that the Minister for Public Expenditure and Reform would give details of the decision at a press conference this morning. It is important for the Deputy to understand the original intention was that every cent that might accrue from the sale of State assets would go towards debt reduction.

Michael McGrath (Cork South Central, Fianna Fail)
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That is what the Government signed up to; it was not included in the original deal.

Pat Rabbitte (Dublin South West, Labour)
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It is what the previous Government signed up to.

Micheál Martin (Cork South Central, Fianna Fail)
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No, we did not.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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The Taoiseach to continue, without interruption.

Pat Rabbitte (Dublin South West, Labour)
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The previous Government did not even know what it was signing up to.

Enda Kenny (Mayo, Fine Gael)
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It was to go towards debt reduction.

Micheál Martin (Cork South Central, Fianna Fail)
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It was included in NewERA.

Pat Rabbitte (Dublin South West, Labour)
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It is better than the old era.

Michael McGrath (Cork South Central, Fianna Fail)
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It was your plan.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Will the Taoiseach, please, proceed?

Enda Kenny (Mayo, Fine Gael)
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Every cent was to go towards debt reduction. Yesterday the Government decided on the sale of State assets, not in a fire sale but for the optimum amount at an appropriate time, to reach a target of €3 billion. The outcome of the discussions between the Minister for Public Expenditure and Reform, the Minister for Finance and the troika was that once the figure from the disposal of State assets reached more than €1 billion, a figure of one third would apply. In achieving a figure of €3 billion in the sale of State assets the State would have €1 billion to invest in job creation initiatives.

With regard to the State assets mentioned by the Deputy in the energy market, the intention is that when the Government decides on the details, there will be a real impact in terms of competitiveness in the market which will be in the interests of consumers and the economy generally. It is not intended to dispose of everything associated with these assets. In the area of energy, it is the energy element of Bord Gáis and some of the power generation facility within the ESB that will be involved. The Minister for Communications, Energy and Natural Resources, Deputy Rabbitte, will consult and in due course will bring to Cabinet his recommendations for the disposal of that element of power generation within the ESB.

Mattie McGrath (Tipperary South, Independent)
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On air.

Enda Kenny (Mayo, Fine Gael)
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The objective of the Government is to have a limit, reaching €3 billion, for the disposal of State assets at the appropriate time and the best opportune price for the State. I do not envisage that any of this will happen this year but I envisage the commencement and realisation of some of the sale of State assets in 2013.

Gerry Adams (Louth, Sinn Fein)
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I did not intend to raise this issue. Today we heard there are historically high numbers of children in sick and dangerous condition on trolleys; that is the matter I wanted to raise. However, I heard the Minister for Public Expenditure and Reform, Deputy Howlin, was to make this announcement outside the House. Is there something odd in that it takes a leader of Sinn Féin to tell this Chamber what the Government is doing, or that the Government does not tell Deputies what is happening?

Enda Kenny (Mayo, Fine Gael)
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It was on national radio.

Pat Rabbitte (Dublin South West, Labour)
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Did you sleep through it?

Gerry Adams (Louth, Sinn Fein)
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Will the Taoiseach confirm that consideration is also being given to the sale of Aer Lingus and Coillte when market conditions are right? He spoke of a sum of €3 billion. That is a wonderful sum of money. On 31 March the Taoiseach will give €3.1 billion as a present to the banks.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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A question, please.

Gerry Adams (Louth, Sinn Fein)
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Therefore, it is a myth to claim that privatisation and deregulation bring competitiveness and efficiency to State bodies. It will mean job losses, increased prices for consumers and big profits for private speculators.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Thank you, Deputy.

Gerry Adams (Louth, Sinn Fein)
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Why did the Government not give the Dáil the courtesy it deserved by making this announcement to those of us, like the Taoiseach, who have a mandate? Is there no respect at all on the part of this Government for Teachtaí Dála?

Enda Kenny (Mayo, Fine Gael)
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It was made perfectly clear to the nation this morning that following the decision of the Government yesterday the Minister for Public Expenditure and Reform, Deputy Howlin, would today make known the details of the decision. I have just given Deputy Adams the gist of it.

Gerry Adams (Louth, Sinn Fein)
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Why did it not happen here in the Chamber? What is the Taoiseach afraid of?

Enda Kenny (Mayo, Fine Gael)
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The Sinn Féin leader is always torn between asking three or four questions. He asked one about the Minister, Deputy Howlin, and I have given him the answer. The renegotiation of this agreement between the Government and the troika leads us to a point where there is a real opportunity-----

Micheál Martin (Cork South Central, Fianna Fail)
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There was no renegotiation.

Micheál Martin (Cork South Central, Fianna Fail)
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Put the three memos made before-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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The Taoiseach, without interruption, please.

Enda Kenny (Mayo, Fine Gael)
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The Government will decide in its own way what assets should be sold. If anything is to happen in respect of Coillte it is the trees rather than the land that will be disposed of; the timber, not the land.

Gerry Adams (Louth, Sinn Fein)
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What about Aer Lingus?

Brian Stanley (Laois-Offaly, Sinn Fein)
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Trees are worth money. They are the assets.

Enda Kenny (Mayo, Fine Gael)
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One third, 33%, of the value of the accrued sales can be used for job creation and investment by the Government and I am sure this will be of interest to the Deputy as well.

Mattie McGrath (Tipperary South, Independent)
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I do not think the Taoiseach can see the wood for the trees.

Enda Kenny (Mayo, Fine Gael)
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We have discussed this in the House on a number of occasions. I have no difficulty with the House having further discussions about it. I have given most of the details involved.

Mattie McGrath (Tipperary South, Independent)
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Nobody is listening.

Enda Kenny (Mayo, Fine Gael)
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The land belonging to Coillte, Bord Gáis energy, some of the power generation of the ESB and the shares in Aer Lingus will all be dealt with at the appropriate time and for the optimum value. There will be no fire sale and 33% will be available for investment in job creation. The target is €3 billion-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Please. Ask your own members to stay quiet behind you.

Enda Kenny (Mayo, Fine Gael)
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-----which is to be split between debt reduction and job creation.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I call Deputy Ross.

Enda Kenny (Mayo, Fine Gael)
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Members can discuss it as often as they like.

Timmy Dooley (Clare, Fianna Fail)
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So the sale of Aer Lingus is not strategic.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I ask Deputies to show some courtesy to speakers and not have a conversation across the floor interrupting people.

Shane Ross (Dublin South, Independent)
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I congratulate the Taoiseach on delivering 1,000 jobs to Deputy Adams's constituency in County Louth. Jobs are a success story for the Government this week. I welcome that some of the privatisation money will go to job creation. We should congratulate the Taoiseach and the Government for achieving that and it is right that we should do so on both counts. However, I issue a little warning. Although the Taoiseach, the Minister for Jobs, Enterprise and Innovation, Deputy Bruton, and the IDA have very successfully delivered jobs this week, I am very worried, as many Members should be, about another project which will lose jobs. This is the project, revived this week, whereby the State will pass the cost of statutory sick leave to small and medium-sized businesses. That is a serious transfer of a problem. It is a hospital pass in which the Government states that although it or the last Government created the problem of absenteeism it intends to give that problem to small and medium-sized businesses to solve. The result of this, as any small businessman under pressure will tell us, is that these businesses will be forced to lay off members of their staff because they cannot afford to pay for this. It is absolutely wrong that a small sector of society which is doing so much for the economy should be victimised in this way. The cost to the State of such lay-offs will negate any benefit which the Minister for Social Protection sees being made in social welfare payments. Will the Taoiseach assure the House there will be no transfer of this burden - a creation of the State - of the cost of sick leave to small businesses which are already so hard pressed and teetering on the brink?

Enda Kenny (Mayo, Fine Gael)
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I thank Deputy Ross for his courtesy in recognising the value of the renegotiation of that element of the agreement, namely, that 33% of the value accrued from the sale of State assets will be used for job creation purposes. I also welcome his observation on the success, in particular of the IDA, in continuing to be a very strong authority for delivering foreign direct investment into the country. The comments by President Clinton and a range of chief executives of major American businesses, and the interest shown by the Chinese Vice President in investment in Ireland are encouraging signs although we have a long way to go.

I refer to the Deputy's question on sick leave. What is needed is an efficient system that is equitable and fair. This matter was raised before the budget. The Government decided not to run with it for the simple reason that it is clearly focused on not putting barriers in the way of small and medium enterprises and small businesses being able to expand and employ people. This problem is far more serious in the public sector than in the private sector because arrangements apply differently to small firms at private level than they do in the public service where, for a variety of reasons, several thousand people are out on sick leave every day. For this reason the Minister for Social Protection has launched a discussion on this matter which will require a real conversation. The Deputy may rest assured the Government's priority is to focus in the best way possible on having no obstacles or barriers to business and in having opportunities for small and medium enterprises to grow. They are the life blood of the recovery of the economy. From speaking to many small operators I understand their concerns about this.

It is a case of a discussion initiated by the Minister for Social Protection taking place to have an efficient and equitable system that operates in the best interests of everybody.

Shane Ross (Dublin South, Independent)
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I thank the Taoiseach. The problem is absenteeism, which has been created by the State. Smaller businesses cannot afford to take this burden. The Taoiseach is as sympathetic as every other Member and he is aware that it is not just a matter of small businesses being crucified by the banks. I am sure members of the Cabinet know there is a large build up of arrears because of small businesses not paying their rates. Their failure to pay rates is not because they are involved in a boycott or a strike on them but because they cannot afford to pay them.

Mattie McGrath (Tipperary South, Independent)
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It is a lot of money.

Shane Ross (Dublin South, Independent)
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This is not a militant group of people who are taking up the cudgels against the State or the Revenue. They simply cannot afford to do this. I suggest the conversation about them taking on this burden should end now because to suggest they can do so is unrealistic. Some businesses could but they will lay off large numbers of their workforce or they will close down.

Mattie McGrath (Tipperary South, Independent)
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They will be gone.

Shane Ross (Dublin South, Independent)
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In addition, if they have to pay for sick leave, they will have to pay for the substitutes for those out on sick leave. I beg the Taoiseach to assure the House once again that, whatever conversation is going on in the Department of Social Protection, this proposal will be stillborn and small businesses will not be asked to bear that burden. He should give them reassurance today that this measure will not be in the budget next December.

Enda Kenny (Mayo, Fine Gael)
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I am aware from speaking to a range of small and medium enterprise owners of the pressures they feel. I met representatives of the banks yesterday evening and I had a constructive conversation about a number of areas ranging from plans to live up to their commitment for lending this year in parallel with the steps being taken by the Government in the jobs action programme and the alleviation of difficulties for business. The meeting was very constructive.

There is little absenteeism in the small and medium enterprise sector and persons who are ill are genuinely out sick. The problem is that the entire bill for sick leave in the public sector comes back to the Department of Social Protection. What is required is a pretty rational discussion about what is happening because this system needs to be managed more efficiently. I am not sure if a real analysis has been done on the reasons several thousand people are out every day in the public sector. When one compares the numbers with those for the SME sector, the rate of sickness is very much reduced. The average number of working days lost in Ireland is higher than the European average because of this. The Minister for Social Protection has started a realistic and rational discussion about how we can have a more efficient system which does not result in an enormous bill going back to her Department on an annual basis.

I am conscious of the difficulties faced by business and that is why both in the budget and in the Finance Bill 2012 every effort has been made by Government to alleviate the difficulties faced by SMEs. That is why we have proposed the microfinance scheme, the partial loan credit guarantee and other facilities they have been looking for to ease the pressure on them. I am also conscious of the fact that local authorities, by and large, have made every effort to stabilise or reduce rates and individual managers, as they have always had, still have flexibility in looking at the account books of individual businesses that are suffering. Let the discussion begin. No decision was taken by Government on this matter.