Wednesday, 10 October 2012
Following yesterday's meeting of the Committee of Public Accounts, we learned that the health budget was in severe crisis. At the end of August the overrun was reported as being in the order of €329 million. By September it had increased to €374 million and is now projected to end up at €500 million by the end of the year. It was RTE which told us last evening that Tallaght hospital had to apply to Allied Irish Banks for an overdraft of €12 million, with a letter of comfort from the HSE. This was not mentioned at yesterday's meeting of the Committee of Public Accounts. Furthermore, the CEO-designate could not confirm whether the HSE had been consulted or involved in the selection of the additional primary care centres. We deduced from his reply that officials had nothing whatsoever to do with the added centres selected by the Minister for Health, Deputy James Reilly.
We also know that Tallaght hospital is not the only one with a massive deficit. Across the country acute hospitals are in dire financial straits, which is having an impact on patients, staff and the broader economy. We have raised these concerns about health overruns since last April and were told by the Taoiseach in this House that everything was under control. We all know where that has ended up.
Promises made on health savings have not been achieved. This has resulted in extra cuts to home help services, for example. More than 1 million home help hours have been severed from families around the country. That is the reality. Are we facing cuts of a similar order across the acute hospital service? The CEO of Tallaght hospital could not confirm on radio this morning that there would not be further cuts. I am asking for a degree of transparency and honesty on this issue.
What is the Government hiding? What is the HSE hiding? Why is the Department hiding very basic facts that the people are seeking? The Minister for Public Expenditure and Reform, Deputy Brendan Howlin, sought the facts three months ago in a letter to the Minister, Deputy James Reilly, when he told him to get personally involved in sorting out the budget. The House would like to know what are the implications of the overruns for patient services.
Will the Taoiseach at least allow a full presentation by the Minister for Health to the Dáil on the financial crisis in the health service in order that we can be told, openly and honestly, what the Government's approach will be in dealing with the crisis? If the Minister is willing to take suggestions from across the House, such an engagement would facilitate this, but we must at least have openness and a transparent approach to the budget. Second, will the Taoiseach ensure, in accordance with what the Tánaiste told me last week, that all documentation on the primary care centre sites is published once and for all in order that we can get to the bottom of what happened and discover why a particular site in Dublin was moved from an open-lease arrangement to a public private partnership? All we are asking for is this basic information.
We are not going to hide behind the wreckage the Deputy's party left behind. We will not hide behind the litany of failures he epitomised in that Department or the litany of consultants' reports he commissioned and did nothing about. The Government was appointed and elected to serve the country. The HSE was a completely dysfunctional organisation. Squashing the health boards together and imposing the superstructure of the HSE on top was supposed to provide the best world-class service right across the health system. However, the Minister for Health found that there was no effective management, no effective financial control and no clear accountability in terms of the programmes being implemented.
Nobody ever said the system would be transformed in the space of 12 months. We understand it is a major undertaking, affecting people all over the country. I listened this morning to the financial director of Tallaght hospital as she set out very clearly an example of what could actually happen here. This is a hospital which had an extraordinary overrrun in its budget but has managed the situation in such a way as to ensure more people are seen more effectively and a better service is given. While its budget has been cut, it still has made savings. The financial director clarified beyond "Yea" or "Nay" that nobody needed to have any worry that he or she would not receive the best level of hospital attention. Tallaght hospital is one of a number, the hospital in Galway being another, which are leading the way. Every hospital wants to be in the same category.
When it comes to the health service, it is not a case of despair, as presented by Deputy Micheál Martin in this House every day. Tallaght hospital is an example of a facility which has made bold decisions in the interests of the effective running of the hospital, decisions which are of paramount importance in terms of patient treatment. Tallaght hospital was approved, in accordance with the regulations, for an overdraft until the end of the year. The actual overdraft of €4 million was cleared, as was clarified this morning, in January this year. Tallaght hospital achieved significant operational savings in 2012 and reduced its year-on-year spending by 6%, despite having to contend with a 5% increase in inpatient numbers and a 9% reduction in its allocation for this year. It is an example of a hospital transforming itself into what we want it to be. The financial director has pointed out that by 2014 management expects to be where it wants to be and where it knows it can be.
Issues that have been raised and are being dealt with by the Minister for Health include decisions regarding consultants, the reform that is taking place in respect of the drugs bill and a range of others which are under consideration.
Tomorrow I will meet the Minister for Public Expenditure and Reform, Deputy Brendan Howlin, and the Croke Park agreement implementation group. The Minister and I expect to discuss with the implementation group other issues that will bring about a reduction in the overall pay bill. I do not accept Deputy Micheál Martin's bleating or the histrionics in which Deputy Sean Fleming engaged at yesterday's meeting of the Committee of Public Accounts, which were a disgrace to any public official. It is about time Deputy Micheál Martin reflected on the reason he did not show some of the anger, curiosity and inquisitiveness he is now showing when he was in charge of the Department.
It is par for the course for him that he does not answer questions and instead filibusters. He avoided answering the two basic questions I asked him. I asked if, in terms of the budget overrun, he would facilitate an open and transparent debate in the House during which the Minister for Health would make a full presentation on the crisis in the finances of the health service.
I do not know whether the Taoiseach has chosen to ignore the problem or whether the Government is in denial about it. I am not inventing the figures; they were provided yesterday, formally and officially, and paint a picture of a problem that has been getting worse from the beginning of the year. The reason is the Minister for Health introduced a budget 12 months ago that was built on sand and was dishonest and flawed. He has allowed the problem to escalate to the current extreme position in which there was an overrun of up to €374 million at the end of September.
Will the Taoiseach ensure such a debate is held in the House? A concerted attempt is being made to hide information and prevent it from coming out. It is prevalent across the Government and has been reflected at committees, especially the Committee of Public Accounts, in dealing with a number of issues recently.
To return to the second question, will the Taoiseach ensure all documentation related to the selection of primary care centres is published? Will he answer with a "Yes" or "No"? Why would he not answer that simple question? Why would he not release the documentation? Will he publish all of it, including that related to the additions made to the list of primary care centres?
The answer to the Deputy's first question is "Yes." I have already made it perfectly clear to the Deputy and other Deputies that there will be an open debate on the financial circumstances the country faces.
May I finish my point, please? The Deputy asked me a question. The week after next the House will discuss the economic situation the country faces as we prepare for budget 2013.
Part of that discussion is to allow for contributions from everybody and anybody on health and every other matter. The Minister for Public Expenditure and Reform wrote to the chairpersons of each of the Oireachtas select committees, including the Select Committee on Health and Children.
In his letter the Minister stated a central theme of the reforms, as set out in the Government programme, was the need to strengthen the role of the Oireachtas, in particular, the Dáil select committees in their important task of scrutinising the proposed allocation of public funds and making a more timely and effective contribution to national budgetary and resource allocation policy. I hope that statement is clear. It is part of the programme for Government and an invitation to have each sector, including health, discussed in detail by the Oireachtas committee set up for that purpose. Instead of walking out, Deputy Micheál Martin and any of his representatives can ask all of the questions they wish at the Select Committee on Health and Children, including questions on information on primary care centres or any other matter they may wish to raise.
I asked for a debate on health. Will the Government publish all the documentation on primary care centres? Why can we not have a debate on the health service in plenary session? We are not getting answers. Will the Government publish the documentation I seek?
Deputies should stop making a show of themselves. I remind them that this show is being broadcast live on television. They are not doing any good to anyone in the House with this sort of behaviour-----
-----Deputy Mattie McGrath, included. I make it clear - I hope Deputies will listen to me - that it is my intention to ensure the person asking a question will receive the protection of the Chair in doing so and that the person replying to a question will also receive the protection of the Chair in doing so. I hope that is understood by everybody.
Gabhaim buíochas don Cheann Comhairle. Mar a deirtear, "chillax" más féidir. Tá an córas sláinte mar phríomhscéal sa nuacht go laethúil anois, le scéalta dona faoi gach lá. Tuairiscí de scannal, billí polaitiúla, scéalta athchóirithe agus áiteanna á ndruidim and no transparency. The Taoiseach is still refusing to publish the criteria for Government decisions. Last night his officials tried to obstruct the work of the Committee of Public Accounts.
Today the news is that Tallaght hospital has sought a €12 million overdraft and the Health Service Executive is running a deficit of €374 million. This is the Minister's fault and, more important, the fault of the Government with its policy of privatisation. It has failed completely to deliver promised savings, tackle consultants' pay or the price of drugs or recoup money from private health insurance companies. It has also failed to bring order to the HSE which is collapsing in crisis. The Taoiseach knows well that the victims of these failures are older citizens, patients and people with disabilities. Yesterday there were 63 citizens on trolleys in Our Lady of Lourdes Hospital in Drogheda and 327 on trolleys in hospitals across the State. All of them are victims of staff cuts, the recruitment embargo and cuts to agency staff numbers imposed by the Minister for Health, Deputy James Reilly, and the Government. Given that every hospital has an overrun, will the Taoiseach indicate how many of them are running an overdraft and how many will run one before the end of the year?
Gabhaim buíochas don Teachta. Níor chuala mé an focal sin go dtí inné, an focal a dúirt an Teachta óg ansin, "chillax". Sin focal nua don fhoclóir.
The details of the overdraft of Tallaght hospital were published on the hospital's website last August. Every hospital signed on for a particular budget figure at the start of the year and we expect them to live within these figures, although that is obviously challenging. It is perfectly in order and within its remit for Tallaght hospital to seek an overdraft of €12 million until the end of the year. A number of other hospitals have availed of similar opportunities. The board of the hospital approved the request for the overdraft and, as I stated in answer to a previous question, the hospital's €4 million overdraft figure for 2011 was repaid in January 2012. Tallaght hospital continues to implement a range of changes which are transforming the effectiveness of the running of the hospital and delivery of services to patients. For instance, at 8 a.m. yesterday, there were four patients waiting in the hospital's emergency department; at 2 p.m. there were two patients waiting in the department.
Tallaght is an example of the delivery of health care services that has been transformed through the national clinical care programmes. It has reduced inpatient stays and increased day-of-surgery admissions. As the hospital’s finance director said this morning, patients attend the hospital on the day of their surgery which is more effective. The hospital also has improved the appropriate placing of patients in the community who have completed their acute treatment but require ongoing nursing care for a time. All of these changes have been undertaken with patient care and safety as a central and paramount issue.
Several other hospitals have had variations in budget. In the Health Service Executive, HSE, July performance report Beaumont Hospital was 13.3% over budget, the Mid-Western Regional Hospital in Dooradoyle, Limerick, 18.9%, Galway University Hospitals, 8.4%, Cork University Hospital, 7.2% and Tallaght hospital, 10.6%. As Deputy Adams is aware, hospitals can avail of an overdraft facility, the equivalent of 7.5% of their allocation, in the final quarter.
The delivery in hospitals of competent management is bringing about a situation where Tallaght is an example of having come from an excessive overdraft to a position where it has been reduced substantially, despite the fact it has a lower allocation and an increased inpatient throughput.
It is an example of real decisions for effective control of the budget and the real effective treatment of patients. That is evidenced by a higher throughput and more effective delivery of service for everyone. As I said to Deputy Martin, it is not a case of a continuous stream of disillusionment and despair that was put up with for too long.
What is happening is a generational reform of the health service. It is challenging. When this is completed, we will have a service which the people's money will be channelled through to ensure the effective delivery of health care for all patients. That is what everyone wants.
Does this just show the state in which we are? What sort of a republic is it that the Government borrows €67 billion from the troika and then gives €64 billion to bad banks, meaning the citizens have to carry the burden they had no part creating? The Labour Party sits idly by while health services are cut even more.
There will be another €750 million in cuts next year. Last week, the Government gave €1 billion to unguaranteed bondholders. Hopefully, I am getting this point through to the Taoiseach. This is not just a failure of a Minister. If he went tomorrow, it would perhaps be good generally for morale. However, it would not make a blind bit of difference because the Minister is implementing the Government’s policy. This is a failure of Government policy. The folks in Fianna Fáil have much to answer for but it is on the Taoiseach’s watch that this is happening.
We can see the Department and the Government now closing ranks. Instead of closing ranks, will the Taoiseach accept he needs to bring forward a supplementary health budget? He has billions to pour into bad banks but no money for failing hospitals. If the Taoiseach can give billions to the bank, can he not provide a supplementary health budget? As I said earlier, the Taoiseach is a compassionate person and he knows the people who are suffering are the patients, the elderly and the vulnerable.
I have just given Deputy Adams examples, as outlined by the director of financial services at Tallaght hospital this morning, of the changes made there to deal with a serious overrun and the decisions taken by the board and personnel to deliver a far more effective service for patients, the central focus of this process. I do not know if Deputy Adams still holds to his proposition to tell the International Monetary Fund, IMF, and the European Central Bank, ECB, to take a hike. If Deputy Adams assumes the country will emerge from the economic challenges it faces by doing nothing, then he really does live in a fantasy land.
At the end of this Government’s period in office, we will have set out the determination for universal health insurance, a health service where money follows the patient and health care is given on the basis of medical need as distinct from a person’s income. This will not be easy. The measures which have been brought about by the Labour Relations Commission in changes to consultants’ pay for new entrants, rosters and so forth will pay serious dividends in the time ahead.
The outstanding moneys from insurance companies are coming through. The reform of drug prices is being negotiated and will reap positive benefits over the next several years. However, it cannot happen overnight. Our focus is when a patient needs care, that they get that care. We want that to be the very best level of attention.
The structure that used to be there did not work in the past. It will not work unless it is changed. That is what this Government is about here.
On the broader front, the Minister for Finance is working to implement the European Council decision of 29 June in respect of the benefit for this country and others of the break between sovereign and bank debt.
As we head into budget 2013, the Taoiseach and his colleagues are slavishly following their austerity programme. Yesterday, the IMF admitted in its world economic outlook that it had underestimated the impact of austerity on our economy. The report stated the IMF had got it wrong by 200%. Every €100 taken out of the economy costs up to €150. In next month’s budget, the Taoiseach intends to take €3.5 billion out of the economy again which, according to the IMF, could cost up to €5.2 billion. It is in this context that Ireland had the second highest austerity measures in the world in 2010, only beaten to the record by Greece.
Yet, the Taoiseach proudly claims he has the country on the path to recovery and his Ministers claim austerity will help us regain our economic sovereignty. How can he seriously tell the House this is correct policy? The mix of austerity prescribed for us is two thirds cuts with one third taxation. We have seen what the cuts mean with the cutting of disability allowance for those under 18 being floated again, along with more savage attacks being considered in the budget. Will the Taoiseach consider rebalancing the ratio of cuts to taxation in the budget so as to ease the burden on the vulnerable in society? Will he ask his masters in the so-called troika to admit they got it wrong and stop these austerity budgets? I have no doubt the Taoiseach will claim the IMF expects growth next year of 1.4%. With planned austerity we will actually need to grow by over 4% to just recover what the Government will cut in December. Will he explain to the House why this is the right policy?
The IMF report is a global report and points out one of the few bright spots in global performance has been that of Ireland.
Our growth rate was 1.4% and it is expected to go beyond that next year. Clearly there are challenging economic circumstances internationally in terms of the superpowers of the United States and China and many other countries and we are well aware of it. For the Government's part, we have agreed a position with the troika, which funds the country, to set out on a programme, which we have renegotiated in part for very good reasons, and to adhere to that programme. Since the people in Ireland made their decision so clearly in respect of the fiscal stability treaty, the National Treasury Management Agency was able to go back into the bond markets with great interest being expressed in the offerings made at that time.
This shows that international recognition of Ireland making headway in a steady fashion in challenging times is very clear and this is why the foreign direct investment line here continues to be strong.
Deputy Pringle should note that we have signed on for a programme under a memorandum of understanding, which we have renegotiated. We are adhering to it. The troika's next visit is due. We have had seven assessments of our country's performance and they have all been positive. They are challenging and I commend the people on understanding that there are challenging times ahead but that the prospect of emerging from the bailout brings with it the opportunity for real growth and a restoration of Ireland's economic sovereignty.
This is why the Government has set it ceilings for the next number of years in terms of spending and we will adhere to these. We will have the effective management of the running of the country changed in a way for the benefit of the people. Everyone understands that these are not easy times but decisions such as yesterday's decision by the Kerry Group represent a vote of exceptional confidence in the country's future and its people. The foreign direct investment line here continues to be strong.
The budget for 2013 will be challenging. We do not intend to change the ratios or figures we have already set out. We intend to make decisions to give effect to them. Deputy Pringle will have an opportunity during the economic debate to make his contribution on what he believes would be feasible and constructive in the interests of all our people.
The Taoiseach has confirmed that there will be no change in the austerity policies of his Government. He noted the troika will be here again next week. If the Taoiseach seeks to review the programme I imagine he will be pushing an open door now that the IMF agrees with the Members on this side of the House that austerity is not working. The Taoiseach constantly points to foreign direct investment and the investment multinationals are making in our economy. That is holding up, but it is not solving the emigration crisis or the crisis of poor people and people depending on social welfare, including low income couples and other people who are suffering. The Government's policies continue to make this worse. They will continue to ensure more than 80,000 people emigrate from the country every year. These are the people the Government should be targeting in the budget. The Government should negotiate with the troika and get the IMF to agree that our budget burden should be eased and I call on the Taoiseach to do this.
I look forward to the economic debate and I look forward to putting forward my ideas but I have no doubt they will fall on deaf ears on that side of the House.
I look forward to Deputy Pringle's contributions. He is in a position to lead by example. If he paid his charge the level of service provided by local authorities would be all the better. When he goes around the housing estates in Killybegs and out through Ardara and wherever else he holds his clinics, he can say to people that the reason the local authority is unable to provide all the services they need is that people like Deputy Pringle have not bothered to pay their household charge when they can well afford to do so.
The position is that the IMF publishes its report on a regular basis. This is a global report and it refers to many countries, one of which is Ireland. The report pointed out that Ireland is making steady progress in challenging times. We are in a programme, as Deputy Pringle is well aware, funded by the IMF, the Commission and the European Central Bank. We have had assessments of that programme on seven occasions. The country has met all its targets.
It is necessary that we continue to do so to restore our economic sovereignty and to have growth again in our economy. I hope we can get a conclusion to the decision of 29 June in respect of the bank debt and sustainability and that we can retrieve a decision in respect of the promissory note and the wreckage left behind by the previous Administration.
Anyway, no one is going to walk in and write a cheque for €11 billion for us. We have to rectify that problem ourselves. That is a challenge for the Government and it will not be easy. I look forward to Deputy Pringle's contribution when the economic debate takes place. Let us see what he has to say and how he can back it up.