Dáil debates

Wednesday, 18 June 2014

12:55 pm

Photo of Micheál MartinMicheál Martin (Cork South Central, Fianna Fail)
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Yesterday the Government accepted that it could no longer stand over cases of people with acute medical conditions and multiple disabilities losing their medical cards. It accepted that discretionary cards should be restored to 15,000 people in that category who lost them, until at least July 2015. Those people, however, will get no refund even though the Government has accepted that it wrongly took the cards from them and has inflicted considerable costs on them.

The Carers Association yesterday estimated that losing the cards would have cost many families up to €1,200 a month. Young Katie Connolly’s condition would cost her family €7,000 a year but she lost her medical card. The Government caused that family considerable distress. This money should be refunded. Will the Taoiseach put in place a mechanism to facilitate that?

I asked the Taoiseach yesterday about the other 15,000 who had lost their medical cards. What is to happen to them? They will not get them back. Over 30,000 people lost their medical cards, according to the Government’s statistics. Only 15,000 are getting them back. Some were paralysed with fear and shock and were not in any position to respond to the infamous letters sent out over the past two and a half years.

Yesterday’s decision also creates further injustices. Thousands of people who since 2011 would have applied for discretionary medical cards, who have acute conditions and disabilities were governed by the same policy framework that governed the removal of the 30,000 cards. They have been refused and will get no medical card, although the Government accepts that the policy framework was wrong and is giving cards back to 15,000 people who lost them as a result. Anybody who receives a new diagnosis in coming weeks or months will be governed by the policy framework the Taoiseach said was wrong, an admission which occasioned his decision to restore the card to 15,000 people. The Taoiseach has to accept this is a shambles and is inconsistent and incoherent.

Photo of Michael Healy-RaeMichael Healy-Rae (Kerry South, Independent)
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It is a disgrace.

Photo of Micheál MartinMicheál Martin (Cork South Central, Fianna Fail)
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Will a refund mechanism be put in place for the 15,000 people who lost their cards, which are now being restored to them? Will the policy framework change for those who applied for cards since 2011, with conditions similar to those of the 15,000, but who never got them? What policy framework will apply to people who are newly diagnosed with severe conditions and multiple disabilities who apply for a discretionary medical card?

Photo of Enda KennyEnda Kenny (Mayo, Fine Gael)
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The Deputy has asked a range of questions. The Government accepts, and the Minister for Health made quite clear, that it is completely unacceptable that families were put through the stress and strain that arose from the decision to centralise the assessment for medical cards. I pointed out to Deputy Martin yesterday that under the Health Act 1970 the cards are governed by the phrase “undue hardship” and circumstances that apply thereafter for access to medical facilities, as distinct from the particular kind of card.

Yesterday the Government made a clear decision to make €13 million available to deal with the return of cards to people who had lost them since July 2011 on a discretionary basis. When a person applies for a medical card and is turned down discretion is applied and in many cases extended, depending on the range of medical circumstances that apply, the general income of the household and so on. When the review was carried out people lost their cards. The Government’s decision yesterday was very clear. It will cost €13 million to return cards to those who lost them on the review which began when centralisation started in 2011.

One of the senior personnel at the Health Service Executive confirmed this morning that it is working flat out to ensure that within the next four weeks those cards will be returned to those 15,000 people, 13,000 of whom received a general practitioner card.

The Deputy mentioned people who applied or were unable to respond because of their particular challenge, difficulty or medical circumstance. The HSE will of course take those circumstances into account because it has to. People can be stressed or under pressure, or for various reasons may not be in a position to respond in the way that one might expect. I know for instance of a couple of cases in which people with motor neurone disease were asked by the computer to respond. They were unable to speak and move and therefore could not respond.

Photo of Seán FlemingSeán Fleming (Laois-Offaly, Fianna Fail)
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Blame the computer.

Photo of Dara CallearyDara Calleary (Mayo, Fianna Fail)
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It was the computer's fault.

Photo of Mattie McGrathMattie McGrath (Tipperary South, Independent)
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It was the computer's fault.

Photo of Enda KennyEnda Kenny (Mayo, Fine Gael)
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The decision yesterday was very clear. Those who lost cards granted on a discretionary basis as a result of the review system will have those cards restored.

Photo of Dara CallearyDara Calleary (Mayo, Fianna Fail)
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Was the Taoiseach talking to the computer as well?

Photo of Timmy DooleyTimmy Dooley (Clare, Fianna Fail)
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He should reboot it.

Photo of Enda KennyEnda Kenny (Mayo, Fine Gael)
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The circumstances of those who were unable to respond for whatever reason have to be taken into account. The Minister for Health was clear yesterday about the non-payment of compensation. In many of the individual cases long-term illness facilities covers the vast majority of the facilities, aids or appliances people - child or adult - might need.

Photo of Micheál MartinMicheál Martin (Cork South Central, Fianna Fail)
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The Taoiseach did not answer my questions. My fundamental point is that there is inconsistency and incoherence at the heart of the decisions he has taken, particularly yesterday’s decision. A child born today with a rare syndrome will be subject to the framework under which 15,000 lost cards which are now being given back. That child will not get a medical card irrespective of the rarity of the syndrome.

In 2013 the Taoiseach and the Minister for Health signed off on the HSE service plan which said there would be policy changes that would bring discretionary medical card numbers down to approximately 50,000. There were 63,000 discretionary medical cards at the beginning of 2013, and 50,000 at the end of the year, as a result of the Government’s policy decisions. Anybody with severe conditions who applied from 2011 on was refused. Those people did not have cards before 2011. How will the Taoiseach rectify the injustice to those people?

The Taoiseach mentioned motor neurone disease. How will somebody diagnosed with the condition in the next three or four months get a discretionary medical card? The same question arises for a child with multiple disabilities. There is a fundamental incoherence and inconsistency here and the Taoiseach needs to deal with that. What has been proposed to date is not satisfactory. Does the Taoiseach accept that his decision is inconsistent and incoherent?

Photo of Enda KennyEnda Kenny (Mayo, Fine Gael)
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No. I do not accept that at all. There is no inconsistency or incoherence in the decision the Government made yesterday. That decision was very clear.

Photo of Timmy DooleyTimmy Dooley (Clare, Fianna Fail)
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There were no changes last year.

Photo of Seán FlemingSeán Fleming (Laois-Offaly, Fianna Fail)
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There were no policy changes.

Photo of Timmy DooleyTimmy Dooley (Clare, Fianna Fail)
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What about the people who did not get them?

Photo of Dara CallearyDara Calleary (Mayo, Fianna Fail)
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They will not get them.

Photo of Enda KennyEnda Kenny (Mayo, Fine Gael)
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The Government decided to make €13 million available for the return of discretionary cards that were taken away from people in the review system.

The Minister for Health has set up the clinical assessment panel to move to a situation in which the medical condition of a person applying for a new card today can be used to give that person access to medical facilities. Over 1,000 submissions have already been received.

Sometimes Deputy Martin avoids things that are important. The Minister made it clear yesterday that in the cases he mentioned, such as a child born today with exceptional circumstances-----

Photo of Micheál MartinMicheál Martin (Cork South Central, Fianna Fail)
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I am not talking about the exceptional. This is one of-----

Photo of Enda KennyEnda Kenny (Mayo, Fine Gael)
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The Deputy is talking about exceptional circumstances. There is no inconsistency in this.

Photo of Micheál MartinMicheál Martin (Cork South Central, Fianna Fail)
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The Taoiseach is not changing the policy framework. He is only doing this for those who lost the cards before 2011.

1:05 pm

Photo of Enda KennyEnda Kenny (Mayo, Fine Gael)
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The right of the director of the HSE to have the discretion to allocate cards on the mercy principle applies.

Photo of Mattie McGrathMattie McGrath (Tipperary South, Independent)
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Yes, but that is not happening.

Photo of Enda KennyEnda Kenny (Mayo, Fine Gael)
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Equally, a doctor can say that a person - a child or an adult - needs a emergency card to deal with his or her circumstances. There is no inconsistency and no incoherence.

Photo of Micheál MartinMicheál Martin (Cork South Central, Fianna Fail)
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There is total inconsistency.

Photo of Enda KennyEnda Kenny (Mayo, Fine Gael)
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The decision is clear. Some €13 million is being made available to restore the medical cards that were taken away following the review of cards allocated on a discretionary basis. The HSE has confirmed this morning that it is working flat out to make sure all of those people get their medical cards back inside the next four weeks.

Photo of Mattie McGrathMattie McGrath (Tipperary South, Independent)
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They should not have been taken off them.

Photo of Enda KennyEnda Kenny (Mayo, Fine Gael)
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That is neither inconsistent nor incoherent.

Photo of Willie O'DeaWillie O'Dea (Limerick City, Fianna Fail)
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It is inconsistent because nothing is being done to help the other people.

Photo of Micheál MartinMicheál Martin (Cork South Central, Fianna Fail)
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What about the cases from 2011?

Photo of Enda KennyEnda Kenny (Mayo, Fine Gael)
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This decision was made after listening to stories of the pressure that is on so many people. I admit that obviously these things should not have happened, with the pressure and the strain they put on many families.

Photo of Michael Healy-RaeMichael Healy-Rae (Kerry South, Independent)
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We told the Government but it would not listen.

Photo of Enda KennyEnda Kenny (Mayo, Fine Gael)
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We are moving to a new system. That is all under way.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The consequences of the targeting of discretionary medical cards cannot be in doubt. The claim that these consequences were unintended absolutely does not stand up.

Photo of Mattie McGrathMattie McGrath (Tipperary South, Independent)
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It was totally intentional.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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This decision has been defended by the Government and by a whole series of voices. The Taoiseach's reference to the centralisation of the processing of medical card applications is merely a smokescreen to cover the Government's embarrassment and hide its shame. The Minister, Deputy Reilly, indicated yesterday that he has received categorical assurances from fellow Ministers - he did not say "all Ministers" - that the €13 million projected cost of reissuing these cards would be new money for the health budget and would not result in cuts elsewhere across the health services. Who are these Ministers? Has the Minister, Deputy Reilly, received a full Cabinet assurance that additional moneys will be provided? Is consideration being given to not utilising this year the moneys that were set aside for 2014 to facilitate the roll-out of free GP care for everyone up to the age of six? Is it possible that some of those moneys will be employed in this regard?

On "Morning Ireland" this morning, the director of primary care, John Hennessy, outlined three criteria that are being taken into account. The second of those criteria is a requirement for the person in question to have completed a review process during the relevant period. There is a huge discrepancy between the number of people in that category, which is 15,000, and the number of cards that have been removed, which is 30,000. There is no doubt in the minds of Deputies across this Chamber that many people who had their so-called discretionary medical cards taken from them looked at the situation and decided there was no point in proceeding with the review process because they could see nothing other than a rollercoaster of culling. Are people who validly held medical cards but did not proceed with the review process to be excluded from consideration now? If the criteria that have been laid down are used, their hurt will be compounded. The primary care reimbursement scheme, which is overseeing the reimbursement of medical cards-----

Photo of Seán BarrettSeán Barrett (Dún Laoghaire, Ceann Comhairle)
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Sorry, Deputy, you are over time. Would you put your question please?

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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My question relates to the need to reimburse families, many of which have children with grave illnesses and disabilities, for the costs they incurred and could not afford over the period from 1 July 2011 to 31 May 2014. That also needs to happen.

Photo of Enda KennyEnda Kenny (Mayo, Fine Gael)
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I appreciate the way the Deputy has phrased his question. One of the issues that arose when the assessment system was centralised was the clear difference between what was being done at various locations throughout the country. People would say, "How come that person was able to get a card when I could not even though I am in the same circumstances?".

Photo of Mattie McGrathMattie McGrath (Tipperary South, Independent)
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It was decided to take them all away.

Photo of Enda KennyEnda Kenny (Mayo, Fine Gael)
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Stick with your scrap metal Bill.

Photo of Michael Healy-RaeMichael Healy-Rae (Kerry South, Independent)
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The backbenchers voted for it.

Photo of Enda KennyEnda Kenny (Mayo, Fine Gael)
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The evidence was that in some locations around the country, the allocations were much higher than in other locations. The centralisation of this process was not a smokescreen. It was designed to ensure the assessment would be fair for everybody. Clearly, there were enormous difficulties for some Members in that regard. It was not a smokescreen at all.

Photo of Mattie McGrathMattie McGrath (Tipperary South, Independent)
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It was a cloud.

Photo of Enda KennyEnda Kenny (Mayo, Fine Gael)
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Deputy Ó Caoláin's second point related to the endorsement of an extra €13 million for the Minister for Health in respect of the return of 15,000 cards to people who lost them following the discretionary review.

Photo of Mattie McGrathMattie McGrath (Tipperary South, Independent)
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Are we taking that off?

Photo of Enda KennyEnda Kenny (Mayo, Fine Gael)
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That is a Cabinet decision. It is a collective decision of all the Ministers of the Cabinet. It is endorsed and decided unanimously in that regard. I hope that deals with the Deputy's second point. The Minister has already dealt with the question of compensation.

Photo of Mattie McGrathMattie McGrath (Tipperary South, Independent)
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He has not dealt with it.

Photo of Enda KennyEnda Kenny (Mayo, Fine Gael)
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The important thing is that the Government has made a clear decision to provide extra money to return 15,000 cards to people who held medical cards or GP cards on a discretionary basis and who completed the eligibility review between 1 July 2011 and 31 May 2014.

Photo of Mattie McGrathMattie McGrath (Tipperary South, Independent)
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The ballot box is powerful.

Photo of Enda KennyEnda Kenny (Mayo, Fine Gael)
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As I pointed out in response to the earlier question, if people were not in a position to respond to the review or complete the range of questions for certain reasons-----

Photo of Mattie McGrathMattie McGrath (Tipperary South, Independent)
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They might have been sick.

Photo of Enda KennyEnda Kenny (Mayo, Fine Gael)
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-----that matter has to be taken into account by the HSE, as confirmed this morning.

Photo of Michael Healy-RaeMichael Healy-Rae (Kerry South, Independent)
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Only for the local elections, they would be getting no cards back.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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On that last point, it is very important that the door is not closed on those who did not respond for a variety of reasons. Many people felt intimidated by the entire barrage that came from the Government, which insisted that this cull must take place in the interests of so-called probity. I hope the door has been left open for such people. Will there be a process of appeal or review for those who have had their cards cut over the relevant period, but who do not receive a letter in the coming weeks as Mr. Hennessy has indicated? Will there be an opportunity for them to present again? What about those who applied for cards on discretionary grounds over the relevant period and had their applications refused? Given that the same criteria of assessment were applied to such people between 2011 and 2014, surely they are equally entitled to have their positions taken into account now.

Those who were holding discretionary medical cards - many voices on the Government benches claimed that such cards never existed - were not the only people to be targeted. What about the over 70s who were targeted during the exact same period? I know of many cases of people over the age of 70 who have gone through undoubted anguish and suffering because they have lost their medical cards and have to depend on GP-only cards, which are very inadequate replacements for what they previously had great faith in.

Photo of Michael Healy-RaeMichael Healy-Rae (Kerry South, Independent)
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All of the Deputies on the other side of the House voted for it.

Photo of Enda KennyEnda Kenny (Mayo, Fine Gael)
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The Deputy has raised a number of questions. The Minister for Health requested a detailed examination of the status on 1 March of this year of the holders of the 78,000 discretionary medical cards that were in circulation on 1 March 2011. I will give the House the relevant information that emerged from that process. On 1 March last, some 33% of them - or 25,398 individuals - still held medical cards on a discretionary basis; some 49% of them - or 37,906 individuals - held medical cards based on assessment of means; and some 19% of them - or 14,621 individuals - no longer held medical cards. Within the latter group, some 2,521 people, or 3% of the total figure, were deceased; some 5,145 people, or 7% of the total figure, did not respond to correspondence from the HSE; some 1,522 people, or 2% of the total figure, initially engaged with the HSE did not complete the review process by providing all the required documentation; and some 5,433 people, or 7% of the total figure, completed the review process only to be found to be ineligible for a medical card. That is the current status of the 78,000 people who held medical cards on a discretionary basis in 2011, based on what happened them between 2011 and March of this year. Those who had their cards granted as part of the discretionary allocation, but lost those cards on review or assessment, will have those cards restored. That will account for a portion of the €13 million cost that the Cabinet approved collectively and unanimously yesterday in order to deal with this matter.

I will not have time to deal with the other elements of Deputy Ó Caoláin's question.

Photo of Catherine MurphyCatherine Murphy (Kildare North, Independent)
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Yesterday, we listened as the Fiscal Advisory Council stated that we must plough ahead with a further €2 billion of adjustments in this year's budget, on the basis that economic growth is uncertain and the national debt is alarmingly high. The idea of a further cut of €2 billion will strike terror into those who have already been ravaged by years of austerity.

With the national debt figure standing at €203 billion, it is the understatement of the century to say it is alarmingly high. It is very much the elephant in the room and until it is addressed, we will constantly be putting out budgetary fires.

We are now into budget season, with departmental meetings under way and groups publishing pre-budget submissions. The Taoiseach will dismiss many of those submissions as fantasy economics. Talking of fantasy economics, my attention is drawn to one of the commitments he gave in the lead-up to this year's local elections, namely, that Fine Gael councillors would reduce the property tax by 15%. Given what the Government has done with the Local Government Fund, is that commitment actually deliverable? There are three main streams of local authority funding. The first of these, the general purposes grant, has been reduced from €999 million six years ago to €275 million in 2014, notwithstanding the subvention of €490 million paid to Irish Water last year. The fund has been decimated. The next stream is commercial rates, and Fine Gael gave a pre-election commitment either to keep those rates static or reduce them.

1:15 pm

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

Photo of Catherine MurphyCatherine Murphy (Kildare North, Independent)
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The third funding stream is the property tax, which is essentially being used to replace the general purposes grant and is estimated to bring in €290 million in 2014. In a recent Sunday Business Post article, Michael Brennan outlined in graphic detail how only nine local authorities will have the capacity to fulfil the commitment to reduce the property tax by 15%.

Photo of Seán BarrettSeán Barrett (Dún Laoghaire, Ceann Comhairle)
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The Deputy is way over time.

Photo of Catherine MurphyCatherine Murphy (Kildare North, Independent)
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What analysis was done prior to the Taoiseach giving his commitment that Fine Gael councillors would reduce the tax by 15%, and will he publish that analysis? What measures will he now introduce to ensure the 15% reduction is at least possible? It seems to me that the only thing that can be done is to reverse the cut in the general purposes fund. Will the Taoiseach agree to do it?

Photo of Enda KennyEnda Kenny (Mayo, Fine Gael)
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I thank the Deputy for her questions. The Government published an agreed economic plan which set out specific targets to bring the deficit below 23% by 2015 and eliminate it by 2018. By balancing the books in 2018, we will no longer have to borrow to fund the day-to-day services provided by the State. This will make Ireland far more attractive for jobs and investment and keep our debt very much under control.

I welcome, as does the Minister for Finance, Deputy Michael Noonan, the input from the Fiscal Advisory Council, which was set up by the Government for a particular purpose. We agree that meeting the deficit target of under 3% next year is critical, and Government policy will reflect that. The Minister has pointed out on many occasions that this is the target and that an adjustment is required to reach it. We cannot say now what that adjustment will be because we have no final view of the national accounts until later in the year. It is too early to make a decision as to what the size of the adjustment will be. It is a lever to achieve the target that has been set out, but 90% of the adjustment has already been made.

The Government's fiscal adjustment plans are in line with the requirements of the new fiscal framework. I am advised by the Department of Finance that the Government is not going beyond the minimum requirements of that framework, and I understand the Department will specifically query the conclusion the Fiscal Advisory Council has reached. The rules of the EU fiscal compact treaty require Ireland to attain our medium-term objective of a structurally balanced budget by 2018. Under the treaty, the European Commission - not the Irish authorities, as suggested by the advisory council - sets out what it calls the calendar of convergence. Like other member states, Ireland is obliged to adhere to the EU fiscal rules, the objectives of which are to prevent a recurrence of the extreme crisis we experienced in recent years and ensure EU economies can grow and jobs can be created.

The commitment the Fine Gael Party gave prior to the local elections was that its elected members would not vote for an increase in commercial rates and would reduce the property tax where that was possible, with a clear indication given that it would not, however, be possible in all cases. The newly elected councils are getting down to preparing their budgets for 2015. The commitment the Deputy referred to was very specific, namely, no increase in commercial rates, the possibility of reducing property taxes where possible and a recognition that such reduction would not be possible in all cases.

Photo of Catherine MurphyCatherine Murphy (Kildare North, Independent)
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The Taoiseach is saying that it is too early to say what the budgetary figures will be, but this did not stop him from making a promise which people took at face value. If one walked into a shop advertising a 15% reduction on all goods only to find there was just one small rail where that reduction applied, one would be a disappointed customer and probably would not return to the shop. This is the kind of thing that gives politics a bad name. The reality is that people heard the commitment given that Fine Gael councillors would deliver a 15% reduction in the property tax. In the autumn we will see local government pitched against national government, and the Taoiseach holds all the cards in that situation.

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

Photo of Catherine MurphyCatherine Murphy (Kildare North, Independent)
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In the absence of reversing the cuts in the general purposes grant, there is no chance of a reduction of 15% in the property tax. The Taoiseach is not giving people at local government level the possibility of effecting that cut. I have asked the Taoiseach if he will reverse the cut in the general purposes grant. Will he also give an absolute assurance that 80% of property taxes collected will be retained in the areas in which they are collected?

Photo of Enda KennyEnda Kenny (Mayo, Fine Gael)
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I always value Deputy Murphy's contributions and I am struck by what she said about certain things giving politics a bad name. There are parties on her side of the Chamber which want there to be no property tax, no water charges and no commercial rates, while also demanding that services-----

(Interruptions).

Photo of Seán BarrettSeán Barrett (Dún Laoghaire, Ceann Comhairle)
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Deputies must allow the Taoiseach to reply to the question.

Photo of Enda KennyEnda Kenny (Mayo, Fine Gael)
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Some of them are unsure as to whether they want them now or later. Some of the parties over there would say that this is not the time to introduce these charges, even though they were very much in favour of them in the past. I agree fully with the Deputy that this kind of politics gives everybody a bad name.

(Interruptions).

Photo of Enda KennyEnda Kenny (Mayo, Fine Gael)
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We were very clear with our members before the local elections that they would not be voting for an increase in commercial rates and would reduce property charges where that is possible, while setting out clearly that it would not be possible in all cases. The Deputy asked whether 80% of property tax revenues will be retained in the areas in which they are collected. The taxes gathered in different parts of the country are dependent on property valuations in those locations and there is a variation in that. We want to ensure that no local authority is in a worse position then it was before. I thank the Deputy for her comment about people on the other side of the House giving politics a bad name. I agree with that.

(Interruptions).

Photo of Jerry ButtimerJerry Buttimer (Cork South Central, Fine Gael)
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Imagine having to make a decision, Catherine. That would be difficult for you.

(Interruptions).

Photo of Jerry ButtimerJerry Buttimer (Cork South Central, Fine Gael)
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What way is the wind blowing, Finian?

Photo of Seán BarrettSeán Barrett (Dún Laoghaire, Ceann Comhairle)
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I ask Deputies to settle down or leave the Chamber. We are moving on to the Order of Business.