Micheál Martin (Cork South Central, Fianna Fail)
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Listening to RTE Radio's "Liveline" programme the other day was a harrowing experience for many people. The broadcast featured Louise Mac An tSaoi, the mother of Liam Mac An tSaoi, a young child who is spending his fourth Christmas in Crumlin Children's Hospital. This is as a result of the failure of the health authorities to provide the necessary supports and funding to enable Liam to go home to Galway this Christmas. This is despite being promised by the Minister for Health, Deputy Reilly, more than 18 months ago that Liam would be sent home and would have the resources to enable him to return to Galway. That promise was broken and the situation is causing enormous strain on the family. Louise gave an account of her own experiences and those of the family as a result of this significant failing. Liam was born prematurely, has had up to 15 operations and requires 24-hour care. Incredibly, despite the fact that the Minister, Deputy Reilly, has been aware of this for more than two years, the package has not been put in place to enable Liam to go home so that the family can spend Christmas together this year. I am highlighting this case because it illustrates the degree to which the health service is at breaking point in terms of providing basic and proper care packages for many sick children and adults.

This case is separate from that of the seven tracheostomy babies of whom we are also aware. They are fit to go home but cannot be discharged because of the lack of proper home-care packages being put in place. The Minister has been aware of this and yet it continues.

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

Micheál Martin (Cork South Central, Fianna Fail)
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These are shocking cases. No mother should have to go on "Liveline" to highlight such a case, which has shocked many people. Will the Taoiseach ensure that the Government provides the requisite resources to enable Liam Mac An tSaoi and other children in similar situations to return home this Christmas? Will the Taoiseach change his policy direction on the health service? He is ploughing ahead with a €666 million cut that it simply cannot take. I meet workers at all levels of the health service around the country who are telling us that the system is at breaking point. Health staff at every level, from clerical officers to frontline workers, are saying that morale has never been lower and they are at their wit's end. It is therefore time for a change of policy on the health service because it can take no more.

Paul Kehoe (Wexford, Fine Gael)
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The Deputy should know; he was there.

Enda Kenny (Mayo, Fine Gael)
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I do not have the details of the case Deputy Martin has raised. I would assume that if any child is in a fit medical condition to be allowed home, he or she will be. If, as Deputy Martin said, this little child requires an exceptional level of attention, I do not think that can be classed as what the Deputy called a basic level.

Clearly, if the child is to go home, there is a duty to ensure that the package of care surrounding any child released in those circumstances is fully effective in the interests of the health of that child. I do not know if, in the context of the home care package, the problem is that there is, according to what Deputy Martin heard the child's mother say, an element of professionalism or expertise lacking in it or if it is a question of the money surrounding it. I do not have an answer to that question but I will get it for the Deputy. No parent should feel that his or her child cannot be sent home because of an issue surrounding the extent or quality of a home care package. It is an issue that I will follow up on.

In regard to Deputy Martin's comments on the health services in general, the Health Service Executive has forwarded its draft plan in respect of the delivery of services in 2014 to the Minister for Health. The Minister is currently examining the plan and has a specific length of time in which to amend or approve it. The impact of the health service plan must be the protection of front-line services and the personnel who deliver them. Patient care must and will be the central tenet of that plan. The Minister for Health will make his recommendations on the draft plan as submitted and will then bring it to the attention of the House. The fundamental issue is the quality of service delivered by professionals on the front line. Any adjustment in allocation must in the first instance ensure protection of those services. This is where the emphasis of the Minister will be.

I will follow up on the case raised by the Deputy.

Micheál Martin (Cork South Central, Fianna Fail)
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The Minister for Health is aware of the case of Liam Mc An tSaoi and promised two years ago that he would not have to spend another Christmas in Crumlin children's hospital. Liam's family are from Galway and will require the support of Galway University Hospital. Liam's mother Louise is a trained nurse. The issue is one of funding and an inability to put together a package to allow for Liam's safe discharge from Crumlin children's hospital.

In regard to home care packages, the Taoiseach is aware that there are seven babies in Crumlin children's hospital who have had tracheotomies inserted and also cannot go home. The advocacy group involved has stated that the numbers in this regard are at crisis level. We are all aware of the challenges and difficulties in facilitating families in these situations in terms of bringing their children home and so on. The absence of funding and resources is preventing these children from leaving Crumlin children's hospital.

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

Micheál Martin (Cork South Central, Fianna Fail)
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I referred earlier to morale in the health service. I invite the Taoiseach to speak to the nurses and doctors on the front line, those who work in the disability services and to clerical workers. When one meets anybody working in the health service, the message consistently is that morale is at an all time low and that patient safety is and will continue to be compromised if the health service plan, in terms of the level of cuts proposed, is accepted, which the Taoiseach envisages will be the case. I believe if the plan is accepted patient safety will be compromised and far more cases of the type I have outlined will be raised in this House.

Enda Kenny (Mayo, Fine Gael)
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The Deputy has spoken previously to nurses, doctors, patients and the people. He was an exceptionally talented Minister in terms of the production of reports without back-up action. I take his confirmation of having spoken to nurses, doctors and people at large without a large grain of salt.

Paul Kehoe (Wexford, Fine Gael)
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Hear, hear.

Enda Kenny (Mayo, Fine Gael)
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I understand that the little boy concerned, Liam, has spent all of his life in Crumlin children's hospital and is now facing into his fourth Christmas there. I would like to confirm a couple of facts for Deputy Martin. Our Lady's Children's Hospital, Crumlin has been liaising with Galway University Hospital in regard to the case of little Liam. The HSE has advised that Galway University Hospital will facilitate the transfer of Liam as soon as is possible. Senior nursing staff at Galway University Hospital have already visited Our Lady's Children's Hospital to assess the child's needs. Full details and an equipment list have been sent to Galway University Hospital. Both hospitals will continue to work together to get Liam to the hospital in Galway as soon as possible.

Micheál Martin (Cork South Central, Fianna Fail)
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Four years.

Enda Kenny (Mayo, Fine Gael)
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I understand that senior staff at Galway University Hospital are in the process of identifying and recruiting staff so that the child's particular care needs can be delivered much closer to his home in Galway. A home care package application was submitted in March 2012 but it was not followed through as the little boy was deemed medically not fit for discharge shortly after this. I do not know the medical details involved but I have undertaken to follow up on the case with the Minister, Deputy Reilly, in the interests of Liam's mother and his family.

Micheál Martin (Cork South Central, Fianna Fail)
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A promise was made two years ago to effect a transfer.

Gerry Adams (Louth, Sinn Fein)
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Every day brings a new revelation about the health services and the scandal of top-ups to senior executives continues to escalate. Hardly a week goes by without some revelation of how corruption and the culture which underpins it has contaminated many sectors of this State. I do not make this charge against the Government, although it has a duty to bring about the necessary changes and reforms in this regard. The issue of top-ups is part of a wider problem arising from a culture embedded in this State of awarding the elite by punishing ordinary decent citizens. The State's saddling of citizens with private banking debt is a perfect example of this. So, too, is the Government's top-up of its special advisers' pay in breach of its own guidelines.

In this regard we need look no further back than yesterday when the HSE told families affected by narcolepsy that they would not get payments because they were suing the State. While the HSE director general has apologised for this, it is an informative insight into how the State works. Citizens were to be punished because they stood up for their rights. Children are kept in hospital because of a failure to provide them with home care packages. All the while, executives are allowed to top up their pay, often with charitable contributions.

Hearings by the Committee of Public Accounts into the CRC are important. It is vital that the former chief executive, Mr. Brian Conlan, and other personnel co-operate with the committee. Will the Taoiseach acknowledge that this problem is bigger than the CRC and that there is an onus on the Government to establish an inquiry into all independent and voluntary health agencies that are HSE funded? Citizens have the right to a full understanding of the scale and extent of this scandal. Will the Taoiseach accept that a full independent inquiry is now needed to get to the full facts of this scandal?

Enda Kenny (Mayo, Fine Gael)
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The Deputy started by saying that every day brings new revelations about other things.

Patrick O'Donovan (Limerick, Fine Gael)
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The Deputy is dead right.

Enda Kenny (Mayo, Fine Gael)
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The Deputy is correct and that does not just apply to the health service or issues about charities and so on.

Sandra McLellan (Cork East, Sinn Fein)
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That is not the question.

Enda Kenny (Mayo, Fine Gael)
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Deputy Adams knows what I am talking about.

Gerry Adams (Louth, Sinn Fein)
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The Taoiseach needs to stop talking gobbledygook and answer the question.

Patrick O'Donovan (Limerick, Fine Gael)
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Deputy Adams is a great man for answering questions.

Sandra McLellan (Cork East, Sinn Fein)
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This is Leaders' Questions. The Taoiseach should answer the question asked.

Enda Kenny (Mayo, Fine Gael)
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Deputy Adams knows a great deal about gobbledygook.

Gerry Adams (Louth, Sinn Fein)
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Answer the question.

Enda Kenny (Mayo, Fine Gael)
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It is a pity Deputy Adams would not answer the questions. I note he has been seeking debates about the past.

Pádraig Mac Lochlainn (Donegal North East, Sinn Fein)
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Is the Taoiseach taking up the offer?

Enda Kenny (Mayo, Fine Gael)
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Perhaps before getting into that Deputy Adams would answer some questions himself.

Enda Kenny (Mayo, Fine Gael)
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We saw Deputy Mac Lochlainn beaten into submission to give the same message.

Pádraig Mac Lochlainn (Donegal North East, Sinn Fein)
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Does the Taoiseach see the men of violence all around him? He should look at all those statues.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Thank you, without interruption, please.

Enda Kenny (Mayo, Fine Gael)
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The question that Deputy Adams asked about-----

Alan Shatter (Dublin South, Fine Gael)
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Deputy Mac Lochlainn is embarrassing himself.

Enda Kenny (Mayo, Fine Gael)
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The question that Deputy Adams asked about top-up payments is the subject of a direction from the Minister for Health to the HSE to deal with this matter, whereby unapproved unauthorised top-up payments that breached the public pay service agreement were paid to certain personnel. The section 38 agencies have been called in before the HSE this week. The Central Remedial Clinic is in before the Committee of Public Accounts tomorrow. I expect there will be frank exchanges at all of these meetings. I do not agree that this warrants an independent public inquiry. I believe that the instructions given by the Minister for Health will be seen through by the HSE and, for its part, by the Committee of Public Accounts, in the discussions they have.

Gerry Adams (Louth, Sinn Fein)
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I came in here to ask the Taoiseach a question which is pertinent to what is happening at this time. It is about revelations which have scandalised citizens. He then goes on a meander which is beyond my comprehension. If the Taoiseach wants to have a debate about the past or about any other issue, I am happy to do that with him. We can arrange that at any time in any place that the Taoiseach is prepared to have that debate with me. We will examine the role of the Taoiseach's party historically, the role of the leaders of the Taoiseach's party historically as well as my role and the role of anyone else involved in Irish republicanism. However, the Taoiseach should not use that issue to dodge the question.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Could we have a question, please?

Gerry Adams (Louth, Sinn Fein)
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The fact is that the issue of top-ups and two-tierism is bigger. I commend and appreciate the work of the Committee of Public Accounts but this is a bigger issue. The Proclamation makes it very clear that citizens have the right to equality. It does not state that is so unless a person is disabled or a child from Galway who has been stuck in hospital for life or because a person is sick. It says that all citizens have the right to equality.

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

Gerry Adams (Louth, Sinn Fein)
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Is it because-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Will you stay quiet, please? Thank you.

Gerry Adams (Louth, Sinn Fein)
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If it is because-----

Alan Shatter (Dublin South, Fine Gael)
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Including the right to life, Deputy Adams should note.

Gerry Adams (Louth, Sinn Fein)
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The Minister, Deputy Shatter, should not nauseate me. Is it because-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Would you please allow the question? You are over time, Deputy. Thank you.

Gerry Adams (Louth, Sinn Fein)
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I am sorry, a Cheann Comhairle, but I expect that I should have order to put the question.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I am trying to do that, but do not respond.

Gerry Adams (Louth, Sinn Fein)
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Try a little harder, with respect.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Excuse me, I do not need any lectures from you about how I respond.

Gerry Adams (Louth, Sinn Fein)
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Will the Taoiseach explain, now that he has said he will not have a full inquiry, why he will not have one? Citizens want to know what is happening within our health services. They want to know what is happening to money which they give to charities for dedicated causes and which are being used to top up already exorbitant payments to these top executives.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Thank you, Deputy. You are over time.

Gerry Adams (Louth, Sinn Fein)
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Will the Taoiseach explain why he will not have a full inquiry?

Enda Kenny (Mayo, Fine Gael)
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Sometimes I wonder from what direction Deputy Adams is approaching the subject. He started off by making a comment and not asking a question.

Gerry Adams (Louth, Sinn Fein)
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I am allowed to do that.

Enda Kenny (Mayo, Fine Gael)
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The statement from Deputy Adams was that every day brings new revelations. If Deputy Adams wants to have a debate about the past, then he should start by clarifying for everyone in the country whether he was a member of the IRA. No one believes him.

Gerry Adams (Louth, Sinn Fein)
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Let us have the debate.

Enda Kenny (Mayo, Fine Gael)
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Deputy Adams continues to live his lie.

Martin Ferris (Kerry North-West Limerick, Sinn Fein)
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Let us have the debate. The Taoiseach should think about what his party has done.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Excuse me, this is Leaders' Questions and there is a time limit. Please answer or reply to the supplementary question.

Enda Kenny (Mayo, Fine Gael)
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Deputy Ferris was not authorised-----

Martin Ferris (Kerry North-West Limerick, Sinn Fein)
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We can have the debate any time.

Enda Kenny (Mayo, Fine Gael)
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-----or those in his cell group were not authorised and were off duty when they perpetrated one of the greatest crimes ever in this country.

Enda Kenny (Mayo, Fine Gael)
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I put it to Deputy Adams that the Government is actively pursuing the question of the health service and the issues that have arisen following an audit of the section 38 hospitals and disability agencies. I agree with Deputy Adams that it is scandalous position to expect people to voluntarily give of their direct debits, flag days, voluntary commitment for collections for charities when they are uncertain whether these efforts are going to the children, adults and the facilities for which they were intended.

Gerry Adams (Louth, Sinn Fein)
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Then the Taoiseach should have an inquiry.

Enda Kenny (Mayo, Fine Gael)
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If we were to follow the logic of Deputy Adams and have another independent inquiry, we would still be inquiring in three or four years' time. The Minister for Health has given a specific instruction to the HSE to call in the section 38 agencies tomorrow. The CRC will be before the Committee of Public Accounts. Does Deputy Adams not believe in the democratic process?

Gerry Adams (Louth, Sinn Fein)
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Of course I do.

Enda Kenny (Mayo, Fine Gael)
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He does. Then, in that case, he should allow the opportunity for the HSE to follow through on the Minister's instructions and engage with these agencies directly to see what is the true situation. The same applies in respect of the CRC with-----

Gerry Adams (Louth, Sinn Fein)
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The IRA?

Enda Kenny (Mayo, Fine Gael)
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-----the personnel there.

I have this to say to Deputy Adams: the fact that the CRC has over the years provided an outstanding service to 4,000 people speaks for itself of the value of what it does. The diversion of some of the contributions and some of the opportunities for top-up payments is a matter that is now being examined. As I said before, the Government has made it clear that unauthorised payments that have breached the public service agreement are not warranted and not acceptable and the matter has to be addressed. It will be addressed.

Gerry Adams (Louth, Sinn Fein)
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When?

Enda Kenny (Mayo, Fine Gael)
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As quickly as possible-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Thank you, we are way over time.

Enda Kenny (Mayo, Fine Gael)
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-----following the analysis by the HSE of the section 38 agencies and charities, and, for its part, the Committee of Public Accounts with the Central Remedial Clinic.

Joan Collins (Dublin South Central, People Before Profit Alliance)
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The Taoiseach has at every opportunity described Ireland as the best little country in which to do business. It seems Forbes magazine agrees. However, I believe the question of whether Ireland is a good little country for the average person in which to try to earn a living needs to be raised. One of the reasons given for moving Ireland to the top of the Forbes list for pro-business countries is that wages have been driven down by 11% since 2008 in Ireland. Employers have used the economic crash and mass unemployment to attack wages and conditions.

I refer the Taoiseach to the industrial dispute involving 2,300 workers at the retail giant, Marks & Spencer, who were out on strike last Saturday en masse. This is a typical example of what is happening. The unions were called in this September by the management to hear the company's proposed cost saving measures. These included a reduction of Sunday and public holiday premium pay, the elimination of contracted Christmas bonuses and a reduction in the number of section managers. The company assured the unions that these were the only items on the agenda. Then, a bombshell came. Despite this assurance, within weeks the company unilaterally announced the closure of the company's defined benefit pension scheme on 31 October. I would like Deputy Stagg to listen to this because it should be of interest to him in respect of workers' rights. This affects 900 long-term staff in the shop. The scheme is performing and has a €17 million surplus. What we have here is a blatant use of the economic crisis to change long-standing conditions and pay for workers. These measures, including the winding up of the pension scheme, mean a cut of between 20% and 25% in pay and benefits for these workers.

As with the ESB workers, who I congratulate on taking a stand and winning the right to defend their defined benefit pension, workers at Marks & Spencer deserve full support in resisting these attacks. Does the Taoiseach accept that making Ireland the best little country for business makes Ireland a difficult place for working people to defend their pay, conditions and pension rights?

Enda Kenny (Mayo, Fine Gael)
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No, I do not. The position is that we are in a very much more competitive situation than we were in the past. The economic crash and the catastrophe that befell us following the bubble in the property market and the conduct of the banks has left many pension funds in deficit.

I am pleased the Labour Relations Commission was able to come to an agreement with management and the group of unions representing ESB workers that there will not be an electricity strike starting next Monday. This would have been catastrophic for business, for reputation and for ordinary people nationwide. I am glad the recommendations of the Labour Relations Commission have been accepted by both sides.

I regret that the workers in Marks & Spencer felt it necessary to have a strike on a busy weekend approaching Christmas. Clearly, this is an issue that must be resolved as one of many pension funds that are in deficit. Deputy Joan Collins will be aware of the Bill is passing through the House at present. It will have completed its passage before Christmas and will be law before the end of the year. This will have an impact in part on some of these pension funds. I agree that given the circumstances in which many pension funds and, therefore, workers find themselves, there is a need to have reflection a and debate on this subject in the new year. Differences exist between those who have just commenced work, those who have moved through with firms, organisations and pension funds and those who recently have retired. There are different sectors with disparate effects following the difficulties that so many pension funds face. While this Bill is going through, the opportunity exists to attempt to resolve all these issues using the well-tried and tested State machinery. Moreover, in the case of the ESB management and unions, use of the Labour Relations Commission enabled the issue to be resolved quite quickly in the interests of everyone in the country.

Joan Collins (Dublin South Central, People Before Profit Alliance)
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The crisis has been used internationally and in Ireland by companies to drive down wages, conditions and pension rights. This is the reality people face every day. The company in question, Marks & Spencer, has stated it has problems but it will not show those problems in Ireland which has not introduced legislation to make it obligatory for companies to reveal their profits and turnover in Ireland alone. Instead, they merely show their international profits. Therefore, it is difficult for unions to negotiate and get such companies to prove their actual costs. The workers involved in this dispute in Marks & Spencer will lose between 20% and 30% of their wages. These workers are committed to mortgages, loans and the future of their children and have made plans on the basis of their current wages. However, on 31 October this company was able to unilaterally wind down the workers' defined benefit pension scheme. Does the Taoiseach stand over that? Does he accept that a company can do this to workers in Ireland or will he stand with those workers and tell them they have the right to strike and to defend their pay, conditions and pensions? Moreover, these workers will be out again next Thursday, as well as Friday of next week, and I appeal to everyone not to pass those picket lines, if the doors are open, to defend these workers.

Enda Kenny (Mayo, Fine Gael)
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One issue with which the Government dealt in the first instance was the reversal in the reduction in the minimum wage and securing agreement about that from the troika.

Joan Collins (Dublin South Central, People Before Profit Alliance)
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These are not workers on the minimum wage. They are attempting to protect their rights.

Enda Kenny (Mayo, Fine Gael)
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The second issue with which the Government dealt was to take 330,000 low paid workers out of the requirement to pay universal social charge. It is well known that practically every defined benefit pension scheme in the country is in difficulties.

Joan Collins (Dublin South Central, People Before Profit Alliance)
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This scheme has a surplus of €17 million.

Enda Kenny (Mayo, Fine Gael)
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Clearly, the fact that in the case of the scheme that was dealt with last weekend, the company concerned is one of the strongest in the country speaks for itself. This is an issue that must be addressed nationally as a country and a people because as time goes on and people live longer, they will have a requirement to draw their pensions for a longer time. This issue must be reflected in the kind of pension scheme that operates and is put in place. It is not nice to see anyone on strike and obviously people have a right to do these things in particular circumstances. It is to be hoped the legislation that is going through will have its own impact but the country and the Oireachtas must decide on the nature of what it is we intend to do about pensions in general for the future, because all these schemes, practically without exception, have a series of difficulties of one sort or another.