Billy Kelleher (Cork North Central, Fianna Fail)
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This week the Government published two reports, "The Establishment of Hospital Groups as a transition to Independent Hospital Trusts" and "Securing the Future of Smaller Hospitals". My party welcomes their publication. There was broad consultation with the professionals who carry out and deliver the services on a daily basis over the past number of years.

To be quite truthful, it is not exactly earth-shattering. When one drills down through the reports, one can see they are a continuation of what was happening in terms of reconfiguration over the past number of years. My difficult, particularly with "Securing the Future of Smaller Hospitals", is that there certainly is not a commitment to secure the future of every small hospital in this country. The Government is talking about holding a consultation process with stakeholders and the broader public, and yet there is a great deal of spin and PR coming from Government that this is guaranteed to secure the future of all small hospitals. The Government's track record on this is not great, as evidenced by what happened in the case of Roscommon Hospital, as well as the abandonment of the proposal for a 500-bed hospital in the north east, to which Fine Gael was committed prior to the last election.

There has been a downgrading of Our Lady's Hospital, Navan, from the provision of 24-hour emergency cover. The intensive care unit is being removed. If there is to be a genuine debate and honesty in this, we need to know exactly what the Government is proposing for Navan. Significant commitments were made. Promises were made about the retention of the 24-hour service because, as was said at the time, it would save lives. The Government is stating quite clearly in this report that the hospital will be downgraded, and this has happened across the country in the case of other small hospitals as well. The key question I am asking today is this: will the Tánaiste give a commitment to the people of Navan that 24-hour emergency cover will remain in the hospital and that there will be no downgrading of services, as was promised by the Minister for Health, Deputy Reilly, in 2011? I merely want to know if the Minister will live up to the commitment that was made and ensure that those services, and the broader services in the north east, are retained.

Eamon Gilmore (Dún Laoghaire, Labour)
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As Deputy Kelleher will be aware, on Tuesday the Minister for Health brought proposals to the Government which will result in the reorganisation of public hospitals into more efficient and accountable hospital groups that will deliver improved outcomes for patients. This represents the most fundamental reform of the Irish acute hospital system in decades.

Professor Higgins's report on hospital groups is based on a comprehensive consultation process and contains almost 60 recommendations on the formation, management and governance of hospital groups. The Minister has taken very seriously his obligation to consider the report closely to assure himself, the Cabinet and the public that it provides a robust basis for enabling timely access to a high-quality and sustainable hospital service for those who need it. The objectives of the groups are as follows: to achieve the highest standard of quality and uniformity in hospital care across the group; to deliver cost-effective hospital care in a timely and sustainable manner; to encourage and support clinical and managerial leaders and to ensure high standards of governance, both clinical and corporate; and to recruit and retain highly qualified nurses, NCHDs, consultants, allied health professionals and administrators for all hospitals.

The introduction of the groups will provide for organisational change in the first instance, giving more autonomy and better enabling the reorganisation of services in a well-planned manner. Over time this will help improve services and deliver better outcomes for patients. The Minister, Deputy Reilly, facilitated a number of briefings on Tuesday in that regard, including with Members of the Oireachtas. I note that quite a number of Members of the House welcomed the fact that they had had the opportunity of hearing at first hand from Professor Higgins on the strategic group's recommendations.

On Tuesday, the Minister for Health also published "Securing the Future of Smaller Hospitals", which offers clear information about the role of the smaller hospitals and what they will do in the future. The framework focuses, in particular, on the role of nine smaller hospitals. In developing the framework to address the development of smaller hospitals, the Government is clear that there is an important future role for smaller hospitals in which they will provide services for more, not fewer, patients; that no acute hospital will close; and that safety issues in all acute hospitals, large or small, must be fully addressed by providing the right type of service for the patient in the right setting. This framework will demonstrate clearly that the future of smaller hospitals is secure. It will set out what services can and should be delivered safely by these hospitals in the interests of better outcomes for patients.

The implementation of the hospital groups report will begin immediately. The Minister intends to seek and appoint a chairman for each group within the next two months. Advertisements to seek other board members will be placed in parallel with the process of appointing the group chairmen and the subsequent appointment of group CEOs and management teams. All appointments will be made based on the competencies that the individual brings to the board in line with the HIQA report on Tallaght hospital and, obviously, there will be reference to representation from geographical areas as well. Once formed, the groups will prepare within the first year of their formation a strategic plan for the delivery of services. These strategic plans will determine the way services are provided within each group. The operation of each group will then be rigorously reviewed in the second year, including all necessary due diligence checks, to determine whether it is in a position to advance to hospital trust status during 2015. These reviews may lead to changes in the composition of the trusts versus the traditional groups, as decided by the Government. This is as it should be.

The announcement represents a major milestone in the health reform programme and the Government is confident that the new groups will deliver a more effective and efficient hospital service for patients in all parts of the country.

Emmet Stagg (Kildare North, Labour)
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Deputy Kelleher should put that in his pipe and smoke it.

Billy Kelleher (Cork North Central, Fianna Fail)
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If the Tánaiste believes what he just read out, it means he was making things up two years ago.

Mattie McGrath (Tipperary South, Independent)
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Burn the bondholders.

Billy Kelleher (Cork North Central, Fianna Fail)
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What he stated is clearly at variance with what was stated prior to the last election with regard to small hospitals. Let us be honest about this. If we are talking about genuine reform, establishing hospital trusts and having engagement with the public so that they can have confidence in the services, we should at least be honest with them.

The people of Navan are a case in point. We have already highlighted the issue in Roscommon but we need fundamental trust between the Government and the people in the delivery of services. Unfortunately, there is more rhetoric than reform and nothing is happening other than a reduction in services to the people in Our Lady's Hospital in Navan. If there is to be reform and engagement between all political parties, broader society and stakeholders, the Government must be honest in its dealings, but in Navan and the north east there has been a withdrawal of fundamental services, where the 24-hour emergency care has been reduced to 12 hours. The intensive care unit is also being withdrawn, and other services will be withdrawn in a process that will clearly undermine the confidence in the discussion on the issue.

The Government parties campaigned with promises but, being honest, they seem to govern with broken promises week after week.

Mattie McGrath (Tipperary South, Independent)
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Hear, hear.

Billy Kelleher (Cork North Central, Fianna Fail)
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May I get an assurance that there will be no downgrading of services in Our Lady's Hospital? When the Minister for Health arrives, may I get a commitment on a new hospital for the north east?

Gerald Nash (Louth, Labour)
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There is much concern for Our Lady's Hospital.

Billy Kelleher (Cork North Central, Fianna Fail)
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Where has the commitment gone for the 500-bed hospital to serve the north east? It was meant to be built in advance of any reduction in services in Navan. That was a solemn promise by the Minister for Health. Is the Tánaiste supporting the downgrading of the services of Navan or will he stand with the people, as he pledged?

Eamon Gilmore (Dún Laoghaire, Labour)
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Our hospital services were a mess before the last election.

Mattie McGrath (Tipperary South, Independent)
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So this is how it starts.

Emmet Stagg (Kildare North, Labour)
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It was a mess Fianna Fáil left behind.

Bernard Durkan (Kildare North, Fine Gael)
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We know why.

Eamon Gilmore (Dún Laoghaire, Labour)
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Fianna Fáil had the opportunity in the 14 years it was in government-----

Billy Kelleher (Cork North Central, Fianna Fail)
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Leave the "14 years" comments behind you.

Mattie McGrath (Tipperary South, Independent)
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Burn the bondholders.

Barry Cowen (Laois-Offaly, Fianna Fail)
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The Government is there two years and things have gotten worse.

Eamon Gilmore (Dún Laoghaire, Labour)
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-----when there was plenty of money available to deal with the reform of our hospitals and it did not do so. This Government is-----

Billy Kelleher (Cork North Central, Fianna Fail)
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Downgrading.

Eamon Gilmore (Dún Laoghaire, Labour)
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-----reforming our hospital services.

Dinny McGinley (Donegal South West, Fine Gael)
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Reform.

Eamon Gilmore (Dún Laoghaire, Labour)
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We are appointing hospital groups-----

Barry Cowen (Laois-Offaly, Fianna Fail)
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This is back of a lorry stuff.

Eamon Gilmore (Dún Laoghaire, Labour)
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-----centred on the teaching hospitals and the universities and medical schools they are linked to. The smaller hospitals within the catchment will be tied to larger hospital groups. This is about making best use of the hospital services. It is about where is the best place to have the major equipment and concentration of specialists, and how to use the smaller hospitals to do the elective-----

Billy Kelleher (Cork North Central, Fianna Fail)
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So the Government was wrong two years ago but is right now.

Eamon Gilmore (Dún Laoghaire, Labour)
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The reform is being done.

Billy Kelleher (Cork North Central, Fianna Fail)
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Which the Tánaiste opposed.

Eamon Gilmore (Dún Laoghaire, Labour)
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The Deputy should not try to scratch around reports to find something in desperation.

Deputies:

Hear, hear.

Eamon Gilmore (Dún Laoghaire, Labour)
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This is about-----

Timmy Dooley (Clare, Fianna Fail)
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The Hanly report

Billy Kelleher (Cork North Central, Fianna Fail)
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Did the Tánaiste support the Hanly report? I am not scaremongering like the Labour Party.

Eamon Gilmore (Dún Laoghaire, Labour)
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The Deputy is the health spokesperson for his party and when this report was published on Tuesday, his correct attitude was to be broadly supportive of it.

Barry Cowen (Laois-Offaly, Fianna Fail)
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We are entitled to read it.

Eamon Gilmore (Dún Laoghaire, Labour)
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He has spent two days trying to scratch through it to see if he can find something in it to criticise.

Billy Kelleher (Cork North Central, Fianna Fail)
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Listen to the people of Navan.

Barry Cowen (Laois-Offaly, Fianna Fail)
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There is plenty to be found.

Eamon Gilmore (Dún Laoghaire, Labour)
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It is not pretty or convincing. Our hospitals are being reformed in a modern way and the Deputy's party failed for 14 years to reform our hospital services.

Billy Kelleher (Cork North Central, Fianna Fail)
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The Tánaiste dismissed-----

Eamon Gilmore (Dún Laoghaire, Labour)
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This Government will reform our hospitals and provide a better quality of hospital care for the people of this country.

Dinny McGinley (Donegal South West, Fine Gael)
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Hear, hear.

Billy Kelleher (Cork North Central, Fianna Fail)
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The Tánaiste is dismissing the people of Navan just as the people of Meath dismissed the Labour Party.

Timmy Dooley (Clare, Fianna Fail)
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They are embracing Mary Harney's legacy.

Pádraig Mac Lochlainn (Donegal North East, Sinn Fein)
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The Tánaiste knows well that it is not always good for police to investigate other police. That is why we saw the establishment of the Garda Síochána Ombudsman Commission, as we had to reassure the public of independent examinations of concerns raised.

Pat Rabbitte (Dublin South West, Labour)
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Has Mary been relegated?

Pádraig Mac Lochlainn (Donegal North East, Sinn Fein)
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Two gardaí in the State - very courageous men - came across issues of serious concern and investigated the matter further. They brought these issues of concern to Garda superiors and hit a wall, as there was no formal investigation. In exasperation and frustration, they brought those concerns to the public domain. What has happened to them since? Our economy and the State was brought close to bankruptcy because too many people did not blow the whistle and shout "stop". Transparency International Ireland last night put out a statement detailing the treatment of these whistleblowers, who are courageous men who have been isolated and put aside. One of them had to leave the force because of these allegations.

As the Tánaiste knows, Garda morale is on the floor. Some 140 Garda stations have closed in recent times and thousands of gardaí have retired and not been replaced. Hundreds of Garda vehicles have been removed. For the first time in the 35-year history of the Garda Representative Association, GRA, it did not invite the Minister for Justice and Equality to its conference. That is the environment we are in. Nevertheless, when two gardaí who love what they do and who believe in fairness, justice and consistency of the law step up to the plate and raise issues of concern, they are brushed aside, criticised and isolated.

What will the Government do to reassure the men and women listening today and over recent days who are working in the public and private sector and who are considering speaking out about concerns they have? What will it do to reassure them that they will not be treated the same way as the two Garda whistleblowers have been treated in such a shameful affair?

Eamon Gilmore (Dún Laoghaire, Labour)
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This issue concerns the fixed charge penalty points. When serious allegations were made last September that some gardaí had improperly cancelled fixed charge notices in respect of road traffic offences, the Minister for Justice and Equality asked the Garda Commissioner to investigate those allegations and the Garda Commissioner, in turn, had an investigation conducted which produced a report that has been published by the Minister for Justice and Equality.

It is important that we consider what we are discussing. For most people, their only contact with gardaí and enforcement of the law is likely to be regarding a road traffic offence, caught on camera speeding or doing something that breaches road traffic laws. They may have been stopped by a garda.

Pat Rabbitte (Dublin South West, Labour)
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Driving over cyclists.

Finian McGrath (Dublin North Central, Independent)
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Leave the motorists out of this.

Eamon Gilmore (Dún Laoghaire, Labour)
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With this issue, there were approximately 1.4 million fixed charge penalty point notices issued. In some cases - less than 5% - the points were cancelled, and approximately half of those cancellations arose from technical reasons, such as the speed sign being in the wrong place, incorrect identification of a car, etc. In turn, a number of cases were cancelled because of common-sense decisions made by gardaí, such as in the case of a person being in a rush to hospital and so on. In some cases, there are questions to be answered, with Garda officers issuing fixed penalty points outside their jurisdiction or where there is no documentary evidence as to why the cancellation took place.

The Government and the Minister for Justice and Equality take those cases quite seriously, which is why the Minister made it very clear, following the publication of the report, that there can be no question of a doubt hanging over the fixed charge penalty points system. People have a right to believe that this is being administered fairly and impartially, with no kind of inside track for anybody. The Minister has made this very clear and set out seven principles to guide the administration of that system, with no question mark hanging over the integrity of the fixed charge notice system in the application of penalty points and no individual receiving preferential treatment because of a perceived status, relationship or celebrity. The law and any discretionary application of it to individuals must be administered fairly and with compassion and common sense.

No member of the Garda force should feel compelled by any person's position, relationship or celebrity status to treat that person any more or less favourably than anybody else. There must be proper oversight and transparency to the discretionary decision-making process and the applicable rules and procedures must be fully complied with. All statutory provisions, regulations, rules and protocols must be readily accessible and where an application is made to terminate a fixed-ticket charge where possible appropriate material to support any application made should be sought, while understanding that in some circumstances no material may exist or be obtainable. He has referred these new procedures to the Garda Inspectorate. The report he has published its being referred to an Oireachtas committee for its examination. Separate to this, the Comptroller and Auditor General is conducting an audit into how the system operates.

Pádraig Mac Lochlainn (Donegal North East, Sinn Fein)
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It has been a bad week for senior gardaí. This week the Garda Síochána Ombudsman Commission published a seven page summary into the public interest investigation into the Garda and expressed concern that the recommendations of the Morris tribunal on the handling of informers, and very serious issues arose at the time, have not been implemented by the Garda Síochána. Senior gardaí were challenged on this and on not co-operating fully. In only 17 of 62 information requests was the information received within 30 days.

When these issues were brought to the attention of senior gardaí and the Tánaiste's colleague, the Minister for Justice and Equality, they chose to batten down the hatches rather than let in the light. Will the Tánaiste allow an independent examination of the allegations? Will he allow someone to speak independently to the two Garda whistleblowers, look through the documentation and examine the issue independently so we can reassure the public that the concerns of the Garda Síochána Ombudsman Commission, about which I spoke last week, and the concerns of the two Garda whistleblowers are dealt with so the overwhelming majority of gardaí, who give so much for us every day and who are struggling with huge wage cuts and reductions in resources, can go out with their heads held high and not be let down by the failure of their senior colleagues to open the windows and let in the light?

Eamon Gilmore (Dún Laoghaire, Labour)
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The windows are being opened and the light is being let in. There was an investigation into the allegations and a report has been published. This report is being referred to the Oireachtas committee. The Oireachtas committee is free to invite in the two Garda officers concerned to hear them directly. It is free to invite in whatever senior Garda personnel they wish to respond and explain what is happening. The Minister for Justice and Equality has referred to the Garda Inspectorate the principles I read out on the new enhanced procedures for the operation of the fixed penalty points system so it will oversee the implementation of these new procedures and report back. In addition and as I stated, the Comptroller and Auditor General is conducting an audit into this.

The place for these issues to be examined is the Oireachtas committee, comprising elected representatives of the people whom the Garda serves very well and to whom ultimately all public services are accountable. This is where the windows will be opened and the light let in when these issues are discussed. As far as the Minister for Justice and Equality and the Government are concerned, the report has been published and put to the Oireachtas committee which is now free to take it forward for whatever further questioning and examination it considers appropriate and to do so in public where everybody can see it.

John Halligan (Waterford, Independent)
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There is something deeply reprehensible about what is happening to disabled people in the country. They have sustained a fundamental attack on their quality of life over the past two years. Their disability allowance has been cut as have their home help hours and the number of personal assistants. The domiciliary care allowance has been targeted along with funding therapies for people with disabilities. The respite care grant was cut in the most recent budget.

I know 128 people with disabilities who also have the mobility allowance. As with thousands of people throughout the country, they are deeply fearful about what will happen to their allowance at the end of June. Having spoken to groups throughout the country this is fast becoming a human rights issue.

I understand the working group appointed by the Department of Health on the mobility grants issue has completed an interim report and is examining the best use of the allowance moneys. I am told the Department of Health has received a memo for other Departments to consider how best to feed back into the interim report. This will come to the Government for consideration, I am told reliably, at next week's Cabinet meeting. Will the Tánaiste confirm whether the recent Department of Health consultation on the mobility allowance has concluded and whether he has read the memo and seen the interim report?

The final payment under the current scheme falls due at the end of June so a Government decision on this issue is imminent. Will the Tánaiste confirm whether the project group has recommended a solution on this issue and whether these recommendations will be implemented before the end of June in time for the existing scheme? Will the Tánaiste confirm whether representatives of all the disabled citizens' groups were consulted by the review group? My information is they were not. Does the Tánaiste not think it is essential the voices of people with disabilities are heard in this process?

The cumulative effect of cuts to allowances in services for disabled people is leaving people throughout the country disillusioned, marginalised and ghettoised. The cost-cutting measures have radically changed how disabled persons integrate into society. The decision on the allowance will be made in a few weeks time. Thousands of people throughout the country are concerned, disillusioned and disenfranchised and so are their families. We need clarity on this now and not in the week the allowance is due when it may very well be cut. We need to give people one month's notice at least on what will happen to the €10.8 million, a relatively small sum of money, provided for those in society who are less well off and disenfranchised and who, with their families, bear a burden which very many of us will never have to bear. We need clarity on this issue today.

Finian McGrath (Dublin North Central, Independent)
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Hear, hear.

Eamon Gilmore (Dún Laoghaire, Labour)
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The Government is very conscious that many people cannot access public transport and rely on supports such as the mobility allowance and the motorised transport payments for their mobility and transport needs. We are also conscious of the Ombudsman's reports and her recommendations that the scheme has been operating outside the law for approximately 12 years. A project group was established to examine how best to meet the needs of people who rely on these supports and to report back within three months. The draft report is with the Minister for Health, and I understand it is his intention to bring it to the Government in the near future. The Deputy specifically asked whether I had seen the memo. I have not, and will not do so until the Minister brings it to the Government.

We have made it clear that funding for the mobility allowance and the motorised transport payments remains ring-fenced, but we are required to place it on a legal footing. The challenge is to find a solution which will best meet these needs in the budget available. At a recent meeting of the Joint Oireachtas Committee on Public Service Oversight and Petitions the Minister for Health, Deputy Reilly, and the Minister of State, Deputy Kathleen Lynch, outlined the dilemma faced by the Department in respect of these two schemes.

It is not a funding matter; it is a legal matter. On the one hand, the Ombudsman has identified that neither scheme is compliant with the Equal Status Acts and that they have been operating outside the law for about 12 years. On the other hand, the extension of either scheme as recommended by the Ombudsman would create serious financial pressure on the health budget. As the Deputy knows, we are not in a financial position to do that right now and it would not be sustainable.

A broader consultation was undertaken as part of the project group's work to ensure that as wide a range of views as possible was taken into account. I am not aware of any interest group that was not consulted, but if the Deputy knows of any interest groups that have not been heard to date, I am sure the Minister for Health, Deputy Reilly, and the Minister of State, Deputy Kathleen Lynch, will be happy to hear from them.

In seeking a solution to address the transport and mobility needs of those who require these supports, we are concerned about the group of people who are currently benefiting under these schemes. However, we also have to consider the needs of the broader group, as the Ombudsman has recommended that they must be looked after on an equitable basis. I am confident that we can find a solution which will meet these needs within the available budget.

John Halligan (Waterford, Independent)
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I am shocked that the Tánaiste would think that spending €10.8 million on many people who are the most marginalised in society would put such financial constraints on the health budget. The mobility allowance is not about going to work or to the supermarket; it is the broader picture. It is about access, integration, independence, human rights and equality. That is how those affected see it. I do not believe the Tánaiste would be insensitive to or in any way dismissive of the most vulnerable in society. Many of us, including the Tánaiste, have met people who are on the mobility allowance. I have been in 128 homes to meet the people affected and I make it my business to check out all my facts and figures. They feel marginalised and think they are being treated insensitively. They do not have the same mobility as we have and they need an extra bit of help. Any attempt to cut €10.8 million from a budget is reprehensible and I would be deeply disappointed in the Tánaiste and the Labour Party if this were done. I am not here to make any derogatory attacks on the Labour Party or the Tánaiste. He knows that I am not that type of person. However, a few thousand people are suffering terribly as they cannot move from their own homes. The Minister for Health said this would be a huge cut in the budget, but many people will be offended if that remark is not withdrawn.

Eamon Gilmore (Dún Laoghaire, Labour)
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Let me be absolutely clear about this. There is no cut in the €10.8 million which is allocated for these purposes.

John Halligan (Waterford, Independent)
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There is a cut.

Eamon Gilmore (Dún Laoghaire, Labour)
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No. Let us deal with the facts. The Government has always been quite satisfied to continue the mobility allowance and the motorised transport scheme. That has always been our position. The Government is not seeking to end the mobility allowance or the motorised transport scheme. What has happened is that the Ombudsman has found that the operation of those schemes does not comply with the terms of the Equal Status Acts, and she has recommended that they be extended to a much wider catchment than those who currently have them. The existing budget is about €10.6 million. The financial consequence of the extension recommended by the Ombudsman would be to raise the figure from €10.6 million to €100 million in the case of the mobility allowance, and €200 million over a three-year period for the motorised transport grant.

John Halligan (Waterford, Independent)
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That is not the question.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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Those estimates are wrong.

John Halligan (Waterford, Independent)
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The estimates are wrong.

Eamon Gilmore (Dún Laoghaire, Labour)
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We are seeking to find a solution by which there will be no reduction in the money that has been allocated, as I said earlier. The money allocated for both schemes is ring-fenced and there will be no reduction in it. We are trying to find a solution that will meet the legal requirement highlighted by the Ombudsman. A project group has been established to examine that and consult with the people affected - that is, those who hold the mobility allowance and benefit from the motorised transport scheme - and the representative groups to which they belong. That process has been done and a report on it is with the Minister for Health. He will bring recommendations to the Government arising from that.

It is important to be clear about this matter. This is not a case of the Government cutting money or deciding to end schemes. This is a case in which the Ombudsman has made a recommendation which clearly states that the operation of those schemes is outside the terms of the Equal Status Acts. She has further made recommendations which would have an enormous financial cost attached to them. Therefore, we are trying to find a resolution that will be legal and that will be within the ring-fenced budget that is already allocated for those schemes.