Dara Calleary (Mayo, Fianna Fail)
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Over the past three and a half years the Government has been at pains to spin that the health service was being reformed and transformed. Figures produced this week show that nothing could be further from the truth. In fairness to the Minister, Deputy Varadkar, since being appointed to the job he has spoken the truth only to be slapped down by the Taoiseach who seems ignorant of the truth.

A few months ago the Taoiseach told us that Fine Gael had tackled waiting lists. He told the Fine Gael Ard-Fheis that the problem was resolved. However, the evidence is very different. The number of patients waiting more than nine months for inpatient or day-case treatment has risen by 1,000% in July. There are now 5,448 people waiting more than nine months for a day-case treatment. There has been a fivefold increase in the number of patients waiting more than a year for inpatient and day-case treatment at Beaumont and there are significant backlogs at the Mater, in Galway, in Cork and at St James's.

In 2011 the Taoiseach said, "My Government is keenly aware of the stress that waiting for treatment causes to the citizens of our country and in response to this the Minister for Health has instructed public hospitals to ensure that by the end of 2011 they have no patients waiting more than 12 months for treatment". Today there are 20,928 patients waiting more than 12 months for treatment. Those are the real figures. They show the extent of the Government's misleading of people and inability to manage the difficulties of our health service. The Government was warned about that and yet it introduced a flawed health budget that took €200 million from hospitals. The cause of these delays was a flawed service plan and now we have the proof.

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

Dara Calleary (Mayo, Fianna Fail)
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In light of the evidence of those waiting list figures, does the Minister agree that the health service plan agreed by the Government and by the Minister, Deputy Reilly, was flawed or at the very least unrealistic and is not meeting the demands of the people? How will the Government resolve the issue?

Richard Bruton (Dublin North Central, Fine Gael)
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I thank the Deputy for the question. I think it is fair to say that everyone recognises the challenges that exist in our health service. Since 2008 the budgets of the Department of Health and the HSE have been cut by €3.8 billion and there has been a very significant reduction in staffing levels. Despite that, the Department of Health and the health services are increasing their treatment of patients. That is the backdrop here. Some 115,000 more patients are being treated in our hospitals today than was the case four years ago; so much more work is being done.

The other aspect clear in today's figures is that the emergency department workload has significantly increased which is putting pressure on elective surgery as it always has done in the past. There is no doubt that there are challenges here, but the truth is that reform in the delivery of the health service remains the only route to resolve these issues. We need to move to systems that can better manage the flow. We still have problems with that. Too many people are turning up in the emergency department when they could be treated in primary care and the strategy is to roll out primary care.

We still have problems with discharges from our hospitals and there is also a strategy to address that. The reform plan is clearly on the right tracks, but there are difficulties as everyone acknowledges. These figures show some areas of significant improvement. As the Deputy can see, the waiting lists for outpatients are much improved and the waiting lists in emergency departments are much improved, but there are other areas where there are continuing challenges.

Dara Calleary (Mayo, Fianna Fail)
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The Minister shout get his head out of the sand. Some 20,928 people particularly appreciate the challenges. The clinical director in the Minister's local hospital, Beaumont, described some of the facilities there as unsafe. The Minister spoke about the difficulty with getting people out of hospital beds. The situation in Beaumont is being worsened by an increasing number of patients fit for discharge but in acute beds while on a waiting list for nursing home beds because the Government cannot manage the fair deal scheme.

The Minister spoke about primary care. What will he say to the 350 GPs who first time ever have been forced to take to the streets to wake up the Government to the reality of the crisis in primary care?

Finian McGrath (Dublin North Central, Independent)
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One cannot even get a trolley in Beaumont, never mind get a bed.

Dara Calleary (Mayo, Fianna Fail)
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In respect of issues with primary care, hospitals and nursing homes, the former Minister for Health, now the Minister for Children and Youth Affairs, is responsible for all of it. It was a flawed service plan. The Government took €200 million out of the hospital budget which had a direct consequence.

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

Dara Calleary (Mayo, Fianna Fail)
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The Minister should wake up. The Government is not transforming the health service. People are on waiting lists. There is a 1,000% increase in the numbers on waiting lists and the Government is ignorant of the problem. I cannot understand why the Minister for Health, who has the courage to tell it as it is, gets slapped down and those who were cheerleaders for this disaster - this crime against citizens of the country - are promoted within the Government.

Richard Bruton (Dublin North Central, Fine Gael)
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I will take no lectures from Fianna Fáil on the issue of health reform.

Michael Healy-Rae (Kerry South, Independent)
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Why not?

Richard Bruton (Dublin North Central, Fine Gael)
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Deputy Calleary's leader committed in 2004 that he would eliminate health waiting lists.

Dara Calleary (Mayo, Fianna Fail)
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After three and a half years, what has the Government done?

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Sorry-----

Richard Bruton (Dublin North Central, Fine Gael)
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He also presided over a Department of Health that increased its budget by 50%-----

Timmy Dooley (Clare, Fianna Fail)
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The Minister should answer for his Government's stewardship now.

Richard Bruton (Dublin North Central, Fine Gael)
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-----and added 30,000 people to the health service, but he still did not resolve any of those issues.

Dara Calleary (Mayo, Fianna Fail)
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From the end of 2011 on.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Sorry, will Deputies stay quiet please?

Richard Bruton (Dublin North Central, Fine Gael)
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Going back over the years - I well remember it - Fianna Fáil had 25,000 people waiting more than six months to have treatment.

Dara Calleary (Mayo, Fianna Fail)
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what about 2014?

Richard Bruton (Dublin North Central, Fine Gael)
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The problems were there in Fianna Fáil's time; it threw money at it and did not deliver.

Timmy Dooley (Clare, Fianna Fail)
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The Minister is in Cabinet and should tell us what he is going to do.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Would you stay quiet, please?

Richard Bruton (Dublin North Central, Fine Gael)
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We have to resolve the challenges in a very difficult environment where budgets and staff numbers are reducing.

Timmy Dooley (Clare, Fianna Fail)
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People are still sick.

Michael Healy-Rae (Kerry South, Independent)
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The people are fine.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Stay quiet.

Richard Bruton (Dublin North Central, Fine Gael)
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Despite that, more patients are being treated, fewer people are waiting for outpatient treatment and fewer people are on trolleys. So progress is being made. However, I am first to acknowledge that this is a challenging area of reform. We have a new Minister who is setting out his priorities and he will get the results in this area.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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Yesterday the Minister for Finance, Deputy Noonan-----

Finian McGrath (Dublin North Central, Independent)
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The comedian.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Deputy Finian McGrath should give it a rest.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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-----was asked to justify the imposition of water charges on citizens and families at a time when the Government beats its collective chest about a recovery. Yesterday he failed to answer that question. Of course, he is not here today; perhaps he is off wooing some unsuspecting cailín to waltz with him.

Bernard Durkan (Kildare North, Fine Gael)
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It will not be Deputy McDonald.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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Today I will return to the issue.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Can we get back to Leaders' Questions, please?

Eric Byrne (Dublin South Central, Labour)
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It is all about taking business-class flights.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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How can the Government talk about a neutral budget as it prepares to land this unjust tax on citizens and families? How is it neutral to land an additional bill on the doormat? How is it neutral to ask families who are just keeping their heads above water to pay yet another bill? Is it neutral to ask families, who are in financial distress and struggling to keep a roof over their heads, to pay for the water they use to wash, to cook and to live?

Is the Minister's own domestic water supply safe? The water in the taps of many people in County Roscommon is not, as I am sure he is aware as he traverses that county looking for people's votes in the by-election.

Frank Feighan (Roscommon-South Leitrim, Fine Gael)
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A total of €20 million was granted a year ago.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Sorry, Deputy.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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Is it neutral to demand a water charge from families who have contaminated water in their taps?

Richard Bruton (Dublin North Central, Fine Gael)
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As the Minister for Finance, Deputy Noonan, pointed out, the recovery Ireland is enjoying has not happened by accident. It has happened because the Government made certain choices, one of which was to broaden the tax base in order that it would not be taxing employment. That had been advised by everyone who has examined the challenge of an economy like Ireland's and we are getting the result from the difficult choices we have made. There are now 70,000 more people at work than when the Government started the Action Plan for Jobs process. As for the prosperity one is starting to see regenerate in the economy, the Deputy's party has opposed every single measure.

Deputies:

Hear, hear.

Richard Bruton (Dublin North Central, Fine Gael)
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It has opposed everything. Its proposals would have spent our capital fund, that is, the National Pensions Reserve Fund, in the very first couple of years.

Peadar Tóibín (Meath West, Sinn Fein)
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The Government itself has spent most of it.

Richard Bruton (Dublin North Central, Fine Gael)
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It would have been blown by now. The Government is now using those resources to fund small and medium-sized enterprises and to fund enterprise growth.

I will turn to the issue of why there must be charges in the area of water. Ireland has struggled with years of underinvestment in the water system. That is the reality and here, in my own city, we are on a knife edge.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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Who is responsible for that?

Richard Bruton (Dublin North Central, Fine Gael)
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As the Deputy rightly points out, many parts of the country do not have an adequate water supply. As nearly 40% of that water is leaking away, it is necessary to invest in a modern 21st-century water system to deliver for jobs, families and everyone. This must be done through charges to generate the revenue to make the investment. The Government's approach has been to establish a State company that will roll out that investment. This was a choice the Government made, which the Deputy opposed. However, it is the right choice. Every country in the world regards water as an important resource in which one must invest and that one must manage properly, which is what the Government is doing. However, the Government also has built into that system genuine reliefs for people who are in difficulty. Those who are in receipt of the household benefit package will get €100 in relief taken from their bill, children who qualify for child benefit will get a free allowance and people with medical conditions will have their payments capped. Consequently, the Government has rolled out a system that is fair but correct. It is the right approach that needs to be taken and we must embed the recovery to be able to enjoy the fruits of the sacrifices people have been obliged to make in recent years.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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The ironic thing is that as the Minister lauds the sacrifices of families across the State, the Government comes back to those same people and seeks more. I asked the Minister to identify how it is neutral for a family that is under financial pressure to burden them with an additional bill. Moreover, it is not any kind of bill but one that relates to something as basic and fundamental as water. The Minister of course has not answered that question because he cannot. He knows, as do I, that it is farcical to talk about a recovery or a neutral budget when one makes such a demand of families. In the real world, people right across the State await the pronouncement of the regulator to find out just how much they will be obliged to pay.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Question please.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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These same families can tell the Minister, as they have told me, that they will not be in a position to meet this bill. They do not regard it as progressive or fair. They do not feel it as a sign of recovery but will experience it as yet another imposition on them, that is, on they very population which at this stage has endured years of austerity and cuts.

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

Mary Lou McDonald (Dublin Central, Sinn Fein)
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How on earth is this a neutral position to take? Could it simply be-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Sorry Deputy, you are over time. Please resume your seat.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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----- that the neutral budget rhetoric is simply camouflage for more pain on low and middle-income families-----

Paudie Coffey (Waterford, Fine Gael)
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It will come from Sinn Féin's magic pot of gold.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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-----the same families the Government has targeted throughout its entire time in government?

Ray Butler (Meath West, Fine Gael)
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Do not fly business class to Australia.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Allow the Minister to reply. The Deputy might be a Minister some day if he keeps the head.

Richard Bruton (Dublin North Central, Fine Gael)
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The reality is that the Deputy's own party announced that it would cut off all the lending lines to the troika and would make the budgetary adjustments all in one year. Sinn Féin was going to lay aside a whole swathe of public services. It was going to push up taxes and would have destroyed the economy with such an approach.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Nonsense.

Richard Bruton (Dublin North Central, Fine Gael)
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That is the reality of the approach Sinn Féin adopted.

Sandra McLellan (Cork East, Sinn Fein)
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Not at all.

Richard Bruton (Dublin North Central, Fine Gael)
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The Government instead has adopted a prudent approach, which now is seeing the benefits. As the Deputy rightly states, the Government will not be obliged to impose any new taxes in the forthcoming budget.

Sandra McLellan (Cork East, Sinn Fein)
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It is imposing water charges, not taxes.

Richard Bruton (Dublin North Central, Fine Gael)
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It will not be obliged to impose any net spending decreases and has reached a position where it now is moving out of the period of difficult adjustment. Moreover, we are seeing the fruits of this in employment growth. This is how one spreads the benefits. This is how one reduces poverty in the country, by addressing those employment needs.

Deputies:

Hear, hear.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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By charging people for water.

Richard Bruton (Dublin North Central, Fine Gael)
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Of course the Government recognises that people do not like to be obliged to pay for a charge which they were not obliged to pay previously.

Sandra McLellan (Cork East, Sinn Fein)
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They cannot afford to pay.

Richard Bruton (Dublin North Central, Fine Gael)
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However, as I set out in my earlier reply, this is absolutely a correct way to manage and expensive resource in which there has been years of under-investment.

Finian McGrath (Dublin North Central, Independent)
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The pipes are still leaking after three and a half years.

Richard Bruton (Dublin North Central, Fine Gael)
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It costs €1.2 billion to deliver water and the thought that 40% of that is being wasted is an appalling vista. It is necessary to make the investment, which is what Irish Water will do. It has a rolling programme of €1.8 billion investment in the water system-----

Finian McGrath (Dublin North Central, Independent)
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Roll it out.

Richard Bruton (Dublin North Central, Fine Gael)
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-----that will upgrade the supply and make it fit for the 21st century to create employment and to support families. This is the choice the Government made and it is one over which it absolutely can stand. It will manage this resource in a more efficient way and will allow resources to drive employment growth.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I see we have a new entrant today. The Deputy is very welcome.

Mick Wallace (Wexford, Independent)
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America has been at war, in the form of troops on the ground, air strikes, drone assassination missions, bloody and violent occupations and illegal covert special operations, almost non-stop since the Vietnam War in more than half a century of bloodshed, terror and violence. In recent years, the Americans have invaded more than 20 countries without United Nations sanction, thereby breaching international law. However, Ireland supports them at every turn and the hypocrisy is frightening. It is not long ago since Members were absolutely shocked by the beheadings carried out by the Islamic State, which are shocking. However, when the Minister went on a trade mission to Saudi Arabia, I asked him whether he had raised the issue of human rights and he replied that trade missions are not the place to raise human rights issues effectively. We appear to have no problem with the fact that an average of 20 beheadings per month take place in Saudi Arabia but yet, we support United States-led sanctions against Russia, which are damaging our own agriculture trade. Can the Minister please explain the basis of this double standard?

In addition, at the International Atomic Energy Agency conference, a vote will be taken tomorrow on a draft resolution from 18 Arab nations that proposes to compel Israel to join the Treaty on the Non-Proliferation of Nuclear Weapons. How mad is it that Israel has never signed up to this? As Ireland voted against this resolution last year, how does the Government intend to vote this time? Israel's recent campaign of collective punishment against the people of Gaza, in which more than 500 children were killed, is nothing short of a genocide. Ireland's decision to abstain from the vote on the Human Rights Council resolution setting up a commission of inquiry into Gaza was a betrayal of these innocent people. Why do we stay silent on the issue of Gaza?

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

Richard Bruton (Dublin North Central, Fine Gael)
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There were a lot of questions there that were rolled into one.

Mick Wallace (Wexford, Independent)
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Three.

Sandra McLellan (Cork East, Sinn Fein)
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I hope the Minister has all the answers.

Peter Mathews (Dublin South, Independent)
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It was a cluster-question.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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It is all about an ethical foreign policy.

Richard Bruton (Dublin North Central, Fine Gael)
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As for the position with regard to ISIS or ISIL, it undoubtedly is an extraordinary challenge to human rights within the area in which it is operating. As the Deputy rightly pointed out, aid workers and journalists have been assassinated in the most appalling situation. This represents a difficult challenge and the Irish Government certainly is alert to the need to get a long-term resolution there. There is a great deal of extraordinary bitterness between the Sunni and Shi'ite Muslim communities, which has been allowed to fester and there is now a very difficult situation to manage. The Deputy also raised the issue of trade missions and whether one uses such missions as a vehicle for human rights. One plainly does not, as trade missions are about bringing Irish businesses to meet their counterparts in different countries. Ireland trades with many countries, to some with policies to which the Deputy might object. However, one must pursue these issues through the arena in which issues of human rights are resolved.

Mick Wallace (Wexford, Independent)
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What about Russia?

Richard Bruton (Dublin North Central, Fine Gael)
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The issue regarding sanctions against Russia has arisen within the European Councils in which Ireland, as part of the European Union, has taken a collective view.

That action came in the wake of the taking over of Crimea by Russia and, following that, a series of difficulties within Ukraine. All of these issues have been thoroughly debated in the public arena and the European Union has taken the view that sanctions are appropriate. Those sanctions have been limited and have initially targeted individuals who were very close to the regime. There has been an effort to increase the level in order to secure a fair settlement that would resolve what is an extraordinarily difficult situation.

Ireland uses foreign policy in a judicious way and we have always valued our neutral stance, which allows us to take positions in a balanced way. In each of the cases cited, if the Deputy submits questions to the Minister for Foreign Affairs and Trade, the latter will provide a thorough briefing. As I said, we pursue a balanced policy and it has always redounded to our respect. This week, once again, there was a recognition that Ireland is playing a very important peacekeeping role, which we will continue to maintain, in the difficult situation in the Middle East. We are committing to maintain our presence there because of the value other countries put on the role of Irish troops and the approach they bring to peacekeeping in the regions where they take it up.

Mick Wallace (Wexford, Independent)
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The Minister says we have a balanced approach and a neutral position in our foreign policy dealings. Do I take it, then, that we will be voting to have Israel signed up to the non-proliferation treaty tomorrow? In addition, if we are so balanced and neutral, can the Minister explain why, on 1 September, when the Minister for Foreign Affairs and Trade, Deputy Charles Flanagan, was asked about the sanctions against Russia, he responded that the invasion of Ukraine is against international law and must stop? On 23 September, when Syria was mentioned to him, he said "targets need to be particularly precise".

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Will the Deputy put his supplementary question?

Mick Wallace (Wexford, Independent)
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There is little sign of balance there. A year ago, the United States threatened to bomb Assad's forces. Now that country is bombing the latter's enemies. The place is gone mad and the United States-led militarisation of the whole region is causing chaos. The United States and its allies are at the heart of the problem; they are not the solution.

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

Dominic Hannigan (Meath East, Labour)
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He is making a Second Stage speech.

Mick Wallace (Wexford, Independent)
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The United States war machine has been nothing short of a destructive force.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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This is Leaders' Questions. The Deputy must put a question.

Mick Wallace (Wexford, Independent)
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Will we continue to support the promotion of the arms industry, no matter what? Are we no longer to have any individual, unique opinion of our own? Will the Government continue to facilitate imperial warfare through the use of Shannon Airport, which has, at this stage, gone too far?

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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In future, the Deputy must confine himself to one topic on Leaders' Questions. I was very liberal today because it is his first time.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Deputy Boyd Barrett should mind his own business. I am trying to guide Deputy Wallace, but people like Deputy Boyd Barrett only disturb the situation.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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This issue is the business of all of us.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I am trying to be helpful, not obstructive.

Richard Bruton (Dublin North Central, Fine Gael)
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I do not doubt Deputy's Wallace's concerns about the situation in Syria and Iraq following the takeover by Islamic State in parts of the region. There is no doubt, as he points out, that the Assad regime was under attack from certain groups, and those groups were being supported by other players. Likewise, there is no doubt that some of the behaviour of those in the Islamic State represents an affront to any reasonable approach. Islamic State is a piracy - not a state, as it presents itself to be.

On the other issue the Deputy raised, Ireland has a very well worked-out approach in respect of any materials that are exported from the State and which could be used in the arms sector or related sectors. We have an export control system which ensures not only that items which could be used in armoury, but also dual-use items are subject to export licensing. That is rigidly policed by my Department operating in conjunction with the Department of Foreign Affairs and Trade. We are very alert to the dangers in this regard.

The Deputy should address his questions on the position that Ireland will take up in forthcoming votes to the Minister for Foreign Affairs and Trade, who can give him the detailed position.