Billy Kelleher (Cork North Central, Fianna Fail)
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I welcome the opportunity to speak on this serious issue, which has highlighted the interference of the Minister for Health in the delivery of health care in the country. We all accept that a Minister should take a hands-on approach in the delivery of health care, but this was a deeply cynical political exercise. There are no two ways of explaining the issue. The fact is that the Minister for Health sacked the HSE board on taking office in April 2011. A short time afterwards, representations were made to the board on the delivery of the hospital in Wexford and St. Luke's General Hospital in Kilkenny. We all accept that people make representations on a continual basis to the Government for the delivery of health care, but on this occasion the Minister interfered with the independence of the HSE to expedite a capital project in Wexford and another capital project in Kilkenny. The HSE had an interim board appointed. The board acts independently, but it was completely unaware of the decision of the Minister to bring the hospitals in Wexford and Kilkenny to the top of the list.

I do not begrudge the people of Wexford or Kilkenny their hospital facilities. The difficulty I have is that on every other occasion when the Minister was rowing back on promises he made previously, he blamed someone else or the independence of the HSE and suggested that a given hospital had to be closed or downgraded because either the HSE or HIQA had directed it. However, on this occasion the Minister had no difficulty acting for two Cabinet colleagues and interfering in the capital projects. This is taxpayers' money. It is not a slush fund to be used by the Minister or his Cabinet colleagues in advancing themselves in their constituencies. We saw another deeply cynical exercise previously with the primary care centres. Unfortunately, the Minister has form in this regard.

The Minister for Public Expenditure and Reform had a role and has questions to answer in this case because he signed off on the original primary care list. I want to know whether there was a quid pro quo involving his scratching the back of the Minister for Health and vice versa in terms of looking after constituency needs above the Minister's responsibility to all people in the country in the provision of health care.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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Let us set aside the red herrings that the Taoiseach and the Minister for Health might try to throw at us in raising these points. Everyone is delighted to see any hospitals or health care facilities upgraded for the people of Wexford, Kilkenny or anywhere else in the country. The point is that this has occurred against a background in which the Minister has closed 24-hour accident and emergency services in Roscommon, hospitals such as Loughlinstown hospital are threatened with downgrading, ambulance services are being hit in areas such as west Cork and accident and emergency services are being hit in Cork city and other parts of the country. Against that background, it is altogether unacceptable that the Minister should interfere to prioritise certain areas for the political advantage of the Government.

Given the imposition of brutal cuts of hundreds of millions of euro in health care services, there should be absolute transparency and fairness in the allocation of the inadequate resources available. This is an indication that, contrary to the Government's promises to end the era of cronyism and stroke-pulling, cute-hoor politics are alive and well. We see it in this instance and we saw it in the selection of locations for primary care centres. It is clear that questions of political advantage and the need to shore up political bases for particular Deputies have taken precedence over fairness in the allocation of scarce resources for health services. It is shameful. As with the location of the primary care centres, we need to see the criteria that lead the Minister to select some sites over others and to interfere, as he has, in the allocation of scarce health resources.

Denis Naughten (Roscommon-South Leitrim, Independent)
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As the Minister for Health was justifying the closure of their accident and emergency facility to the people of Roscommon, he was pushing through proposals for the upgrading of two further accident and emergency units in Wexford and Kilkenny. While I do not begrudge the people of Wexford and Kilkenny, the argument has now been made that the issues in Roscommon were different and that the closure was a matter of safety. The Minister articulated this case in the House in July 2011 when he stated that patients attending University Hospital Galway had a 5.8% mortality rate compared to a 21.3% mortality rate in Roscommon, which was four times greater. These allegations were immediately contested by a consultant at the hospital as well as by Senator John Crown, who had reviewed the actual figures. The mortality rate in Roscommon at the time was 4.92%. According to the Minister's own argument, Roscommon County Hospital was safer than University Hospital Galway, where patients of the former are now being treated. Subsequently, Dr. Jennifer Martin of the Department of Health informed us that those figures were based on a report compiled to examine the quality of data and not the care provided in acute hospitals. Notwithstanding the fact that the Minister's evidence was based on faulty figures and not faulty care, he has failed to correct the record in the House, apologise to the staff at Roscommon County Hospital whose professionalism was undermined or publish the report which has been imminent for the last 18 months. It raises the question: why?

Another key question is what capital projects were delayed by the decision to fast-track the upgrading of Kilkenny's and Wexford's accident and emergency departments. Reports are being circulated that the delay in delivering the new endoscopy suite at Roscommon County Hospital, the Government's replacement for the closure of the accident and emergency department, is due to the need for funding to deliver the new accident and emergency services in Kilkenny and Wexford. In July 2011, the Minister was committed to putting Roscommon's temporary endoscopy suite in place by September of that year and to instituting a permanent facility by early 2012. Some 18 months later, we are at the stage of seeking planning permission for the permanent facility and have been told the temporary endoscopy suite is too expensive.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It is clear that the upgrading of emergency departments in Wexford and Kilkenny is necessary and welcome. The issue is that they were fast-tracked ahead of other necessary projects by the Minister, Deputy James Reilly, at the behest of his Cabinet colleagues Deputy Brendan Howlin and Deputy Phil Hogan. That is the information with which we have been provided through a freedom of information request by RTE. In early June 2011, both Deputies announced the capital projects for the upgrading of Wexford General Hospital and St. Luke's General Hospital in Kilkenny. This was prior to the HSE board meeting of 9 June 2011, the minutes of which report the reaction of Mr. Brian Gilroy, which I place on the record of the House as follows:

In view of the announcements by the Minister for Public Expenditure and the Minister for the Environment in relation to capital projects in St. Luke's Hospital Kilkenny and Wexford General Hospital, revisions to the capital plan may be required. B. Gilroy will consult the Department of Health and Children and report on this matter at the next meeting.

James Reilly (Dublin North, Fine Gael)
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When I was in opposition, I stated that my absolute priority would be to reduce the number of patients on trolleys. When the Government came into power, I reiterated that position. Patients deserve world-class health facilities in which they are not left suffering on waiting lists or on trolleys in overcrowded hospitals. I cannot deliver the type of health system patients deserve in sub-standard accident and emergency facilities operating from converted pharmacies or where medical assessment units are operating out of reconverted laundries and portakabins. That is the situation in Kilkenny and Wexford. I cannot continue to make the progress required in health if I tolerate such poor standards. I am taking a hands-on approach, as I promised in Opposition and on taking office, and delivering results for patients, which include 20,352 fewer patients on trolleys in 2012 than in 2011, a reduction of almost 24%. By the end of December 2012, the number of adults having to wait more than nine months for inpatient and day-case surgery was down to 86 from a total of 3,706 in December 2011, a reduction of 98%. The number of children waiting more than 20 weeks for inpatient or day-case surgery was down to 89 from 1,759 in December 2011, a 95% reduction. The number of patients waiting more than 13 weeks for routine endoscopy procedures went down from 4,590 in December 2011 to 36 at the end of 2012, a 99% reduction.

For the first time in the history of the State, we have counted the true number of people waiting on outpatient lists, of whom there are in the region of 380,000, a daunting figure. Many people have been waiting for years. We have undertaken that by the end of this year, no one will wait longer than 12 months for an outpatient appointment. Some 16,000 people have been waiting longer than four years. For the first time, we will have real facts and figures which are verifiable. We do not dispute the morning trolley count with the INMO; we have a joint figure. These figures can be checked and are worth repeating. There has been a reduction of 24% in the number of people on trolleys, of 98% in the number of people waiting nine months or longer for inpatient treatment and of 95% in the number of children waiting more than 20 weeks.

I visited Wexford's emergency department, as I visited nearly every such department in the State, and I was taken aback by what I saw. There were overcrowded, cramped conditions with five cubicles and patients on full display on trolleys in the central area of what was a converted pharmacy. The new Wexford project will address these issues by providing 17 treatment bays and a separate treatment area for children. Approximately 40,000 attendances take place at that emergency department per annum. The new Kilkenny project comprises an emergency department, a medical assessment unit and a day services unit, including endoscopy, construction of which has started. This is the first medical assessment unit in the country introducing a new way to treat patients in a more civilised fashion, which also takes a great deal of pressure off the emergency department. The real point is that both projects were approved for inclusion in the HSE capital programme in 2006 and have been included in all of the HSE's multi-annual capital plans ever since.

As the House will be aware, one of the issues for many years concerns capacity issues in accident and emergency departments. Since 2006, capital funding has been made available for an accident and emergency department initiative to provide admission managers and a series of medical assessment units to relieve the pressure on accident and emergency departments. Continuing to address these capacity issues has always been a fundamental aspect of the HSE's capital plans. The 2008 capital plan contained funding to complete developments under way, deliver new accident and emergency departments and upgrade and extend existing departments. The Wexford and Kilkenny projects were part of this initiative.

Olivia Mitchell (Dublin South, Fine Gael)
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The Minister's is up, but if there is a particular point he wants to make, he could make it and come back in later.

James Reilly (Dublin North, Fine Gael)
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The key point is that both projects have been on the list for a long time. I was delighted to be able to receive an extra €12 million for the capital fund from the Department of Public Expenditure and Reform in order to expedite the sorely needed facility in Wexford General Hospital. I will address the issues raised by some of the Deputies, in particular the disingenuousness shown by Deputy Denis Naughten when he suggested the provision of capital funding for this project had delayed the provision of the endoscopy unit in Roscommon. It has not. The level of new services provided in that hospital and the increased footfall to which I can refer in my final response prove the point that this hospital been well capitalised, including the money spent by a previous Government on the accident and emergency department. It was well known that the service provided was not safe, as adjudicated on by HIQA. Deputies Denis Naughten and Luke 'Ming' Flanagan were at the meeting with Deputy Frank Feighan and me when Tracey Cooper of HIQA made it very clear that the service was not and could not be made safe. I gave an undertaking to support the hospital and we have done so. There is much greater footfall than before. I can go through the data later.

Olivia Mitchell (Dublin South, Fine Gael)
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The Deputies have one minute in which to respond.

Billy Kelleher (Cork North Central, Fianna Fail)
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The Minister toured many hospitals when in opposition and has toured a few more in government. It is welcome that he is visiting accident and emergency departments in hospitals throughout the country. The point is, however, that he personally interfered in the selection process for priority capital projects. He says the hospitals concerned deserve it. Of course, they do and we do not dispute this for one moment, but the fact is that the HSE which was established independently of this House was not even aware of the decision made by the Minister on foot of representations made by two of his Cabinet colleagues. Clearly, he could ask himself whether the hospitals in Roscommon, Navan and Monaghan would receive priority if Ministers from these areas made representations, while others would lose out. That is the key question. Resources are scarce and the capital budget is always under pressure, but there was interference in the selection process on foot of representations made by the two Ministers. The Minister acceded and rode roughshod over the independence of the HSE in delivering capital projects.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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None of this would be happening were it not for the fact that the Government is committed to imposing unsustainable cuts on the health service under the troika agreement. Given that this is the decision made by the Government, it is vitally important that there is fairness, complete transparency and accountability when it comes to the allocation of scarce resources. What we discovered in the primary care scandal, for that is what it was, and now in the prioritisation and acceleration of projects in Wexford and Kilkenny is not fairness and transparency but political interference in order to shore up political bases. It is the cronyism and cute hoor politics which the Minister decried during the term of office of the last Government and which was a corrosive cancer in the body politic that helped to get the country into the mess it is in. The Minister is perpetuating that kind of politics by interfering in this way instead of decisions on the allocation of scarce resources being made purely on the basis of need and fairness.

Olivia Mitchell (Dublin South, Fine Gael)
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The Deputy is taking up the time of others.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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That is the allegation being made which the Minister has not addressed yet again.

Denis Naughten (Roscommon-South Leitrim, Independent)
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The Minister is correct in saying the number of trolleys has gone down, for which he is to be commended. He might, however, explain why up to 12 months ago there was no problem with trolleys in Portiuncula Hospital, while there has been a significant problem for the past 12 months because of the closure of the accident and emergency department at Roscommon.

On the accusation that I am being disingenuous, I again ask the Minister to correct the Dáil record. He has been asked to do this on numerous occasions. He said Roscommon County Hospital was four times more dangerous than Galway University Hospital. His officials have contradicted this in his presence, but he has yet to correct the Dáil record. Will he clarify that it was a faulty figure in the statistics presented about Roscommon County Hospital 18 months ago? Will he take the opportunity to once and for all correct the Dáil record? He might explain why the mortality report has not been published, even though it was said to be imminent 18 months ago. Will he tell us when it will be published?

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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What engagement did the Ministers for the Environment, Community and Local Government and Public Expenditure and Reform have with the Minister prior to making their announcements in early June 2011, prior to HSE board meeting on 9 June? Did the Minister indicate to them that he would ensure the projects would be fast-tracked or that he would see to it or was it just a case of "wink and say nothing"? The Minister seeks to give the impression that there is nothing irregular. The Taoiseach also attempted to give the same impression during Leaders' Questions. Perhaps it is not irregular, but the key point is that there is certainly something rotten at the core of the decision-making process. It seems to be a case of "hear no evil, see no evil, speak no evil" for the Ministers concerned. It is high time the Cabinet chimps came here and told the truth.

James Reilly (Dublin North, Fine Gael)
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In response to the last contribution, it would be nice if Deputy Caoimhghín Ó Caoláin's party came in here and told the truth sometimes.

I will address the issues raised by Deputy Denis Naughten. We have made it very clear that the situation in Roscommon was unsafe, as dictated by HIQA. The Deputy was at that meeting. Since Mr. Bill Maher took over the Galway-Roscommon Hospital Group, the Galway figures have been an exemplar for what can be achieved in terms of the number of trolleys at Galway University Hospital which had the largest problem, where 40 to 50 patients were regularly on trolleys and the average figure was 27. It is now down to seven. There would have been 9,901 people waiting for nine months or longer for inpatient treatment and as day cases by the end of September before Mr. Maher took over in January 2011. That figure was nil by the end of September. He has increased footfall at Roscommon County Hospital which is busier than ever. It provides urology services, while there is plastic and reconstructive surgery and a sleep apnoea clinic that had not been available before. There has also been a radiology service upgrade. The development of the endoscopy suite continues apace and planning permission has been applied for. The existing endoscopy unit has JAG accreditation. There are new dental services and nursing initiatives centred on nurse prescribing, including X-rays, as well as nurse-led clinics. There is also a colo-rectal clinical nurse specialist. We hope it will be successful in being one of the endoscopy centres used for the screening programme.

Denis Naughten (Roscommon-South Leitrim, Independent)
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What if one has a stroke or heart attack?

James Reilly (Dublin North, Fine Gael)
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I did not interrupt the Deputy. In respect of outpatient and day cases, the figures show a major increase in the number of patients being treated, which is what people want. They want safe treatment to be provided as near to home as possible. They do not want to be misled into believing they have access to an accident and emergency department that can deal with complex fractures, bleeding and vascular problems when there is nobody available to deal with them. There cannot be because we cannot have vascular surgeons in every hospital in the country, as the Deputy knows.

Olivia Mitchell (Dublin South, Fine Gael)
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We are not having a debate now. Time is up.

James Reilly (Dublin North, Fine Gael)
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I saw in the media that the first issue out of Deputy Billy Kelleher's mouth was that of a slush fund for political gain. It is not surprising that he came out with this because that is exactly what Fianna Fáil did for 12 years, but that is not the case in this instance. I have in my hand Special Report No. 70 of the Comptroller and Auditor General. It states on page 42 that a new department at the Mercy Hospital was completed and opened, that a new department was completed at Drogheda and that a new extension was completed and operational at the Mater Hospital.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I ask the Minister to answer the questions put to him.

James Reilly (Dublin North, Fine Gael)
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In Letterkenny a new emergency department is under construction. Construction work is ongoing at Sligo General Hospital.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Please answer the question.

Olivia Mitchell (Dublin South, Fine Gael)
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The Minister has the floor.

James Reilly (Dublin North, Fine Gael)
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The unit in Cavan is under construction. The hospital in Wexford was stuck at design stage since the previous Government was in office. Was that a political decision? When I took office as a new Minister, why would I continue to engage in Fianna Fáil's policies if I had offered something different to the people?

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I ask the Minister to outline to the House the points of contact he had with the Ministers for Public Expenditure and Reform and the Environment, Community and Local Government prior to their announcements.

Olivia Mitchell (Dublin South, Fine Gael)
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The Minister should conclude.

James Reilly (Dublin North, Fine Gael)
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That was done for the first time, even though there was less money and fewer staff available.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Please answer the question.

James Reilly (Dublin North, Fine Gael)
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Despite the Deputy's shroud waving last February, we have reduced the number who have to wait for services at all levels.

Olivia Mitchell (Dublin South, Fine Gael)
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I ask the Minister to conclude as he has greatly exceeded his time.

James Reilly (Dublin North, Fine Gael)
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We have not only maintained a safe service but also improved it.

Olivia Mitchell (Dublin South, Fine Gael)
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It is not fair to keep other Deputies waiting.

James Reilly (Dublin North, Fine Gael)
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I am determined to continue the reform agenda. In the coming weeks we will issue the new hospital groups document, the small hospitals framework document, the money follows the patient document and the universal health insurance paper. Reform continues apace and none of these distractions will deter me from the course.

Olivia Mitchell (Dublin South, Fine Gael)
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The Minister will have other opportunities to make his case.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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How many other hospitals have been allocated specific funding by the Minister for Public Expenditure and Reform?