Joe Higgins (Dublin West, Socialist Party)
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1. To ask the Taoiseach when the last meeting of the Cabinet committee on health took place. [31777/15]

Joe Higgins (Dublin West, Socialist Party)
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0. To ask the Taoiseach when the last meeting of the Cabinet committee on health took place.

Micheál Martin (Cork South Central, Fianna Fail)
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3. To ask the Taoiseach if the Cabinet committee on health met to discuss health services during September 2015. [32869/15]

Gerry Adams (Louth, Sinn Fein)
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4. To ask the Taoiseach when the Cabinet committee on health last met. [42221/15]

Gerry Adams (Louth, Sinn Fein)
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5. To ask the Taoiseach the number of meetings of the Cabinet committee on health that have taken place in 2015 to date. [42222/15]

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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6. To ask the Taoiseach when the last meeting of the Cabinet committee on health took place. [42433/15]

Enda Kenny (Mayo, Fine Gael)
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I propose to take Questions Nos. 1 to 6, inclusive, together.

The Cabinet committee on health last met on 2 November. The Cabinet committee also met on 13 July and 29 September.

There have been eight meetings of the committee to date in 2015.

Micheál Martin (Cork South Central, Fianna Fail)
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The committee met on 2 November and 13 July.

Enda Kenny (Mayo, Fine Gael)
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And 29 September.

Micheál Martin (Cork South Central, Fianna Fail)
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I presume the other five meetings were before July-----

Enda Kenny (Mayo, Fine Gael)
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Yes.

Micheál Martin (Cork South Central, Fianna Fail)
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-----if there were eight meetings.

Enda Kenny (Mayo, Fine Gael)
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Correct.

Micheál Martin (Cork South Central, Fianna Fail)
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The health situation is in chaos, morale is at an all-time low and a fundamental decision has been taken by the Government to end the implementation of the universal health insurance scheme, which was a pillar of Government policy for the past five years and of the Fine Gael Party for the past decade. The programme for Government was consistently very clear over the past five years that universal health insurance would be introduced. We have had an announcement from the Minister for Health, Deputy Varadkar, that the scheme will never be introduced, following a report by the Economic and Social Research Institute stating it would cost families and children thousands of euro more, and would cost the country billions, with no great outcomes.

In many ways I am surprised there was only one meeting, which was on 2 November. Prior to this, the Taoiseach will recall that on Leaders' Questions and the Order of Business I consistently asked about the universal health insurance scheme and the legislation on it. The Taoiseach kept telling me it would be introduced and would happen. It seems the meetings have dried up in the latter half of the year despite the fact a fundamental reversal of policy was under way and being considered, and the only issue was when to announce it. The Minister took his opportunity when other events were grabbing the headlines to try to slip through the reversal and fundamental U-turn on Government health policy. Will the Taoiseach indicate why there has been only one meeting of the Cabinet committee on health since 13 July given the fact such a fundamental policy U-turn and change was under way and given the fact the emergency departments in our hospitals have been consistently reporting record numbers of patients on trolleys?

Waiting times and waiting lists have gone through the roof and spiralled out of control in almost all hospitals across the country. We are facing the first national nurses' strike in a long time as a consequence of the chaotic, unsafe and very worrying practices under way in our overcrowded emergency departments, the circumstances and conditions that have been created as a result of that overcrowding and the low morale within the health service. In all these circumstances, why has there been only one meeting of the Cabinet committee on health since 13 July?

Does the Taoiseach agree there has been no meeting because the system is not working? All we have witnessed has been decline and more decline in terms of the quality of service and the working conditions of doctors, nurses and other health care staff in hospitals across the country. Is the paucity of meetings in the latter half of the year reflective of the Minister going it alone and not really taking heed of the wider Cabinet? I recall the Taoiseach saying two years ago that he was taking charge of the health service himself, but he abandoned that fairly quickly. Whatever system is in place in terms of the Cabinet sub-committees, the lack of any regular meetings in the latter half of the year more or less stands up the view that from a policy perspective, nobody really knows what is going on now at the heart of Government and that the entire programme for Government on health lies in tatters as a consequence.

Enda Kenny (Mayo, Fine Gael)
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I do not accept that at all. The Government has been absolutely united in making the decisions that enabled us to be recognised as the fastest-growing economy in Europe for the second year running, to have created, by virtue of people's ability, more than 135,000 jobs, and to have driven the engine that is providing the resources to fund the public services we need. The Government set out its stall very clearly in undertaking to introduce universal health insurance. We then had the courage to face up to the situation when it became clear the specific model of universal health insurance was going to prove too costly. When political parties or governments decide to do things and have big ideas, it sometimes transpires that the nature of the specific issue turns out to be different but, because of a sense of allegiance to or pride in the original idea, they drive on through. This was the case, for instance, with the setting up of the Health Service Executive. That seemed to be a very good idea but it was foisted on top of a health board system that was not able to absorb it. Another example is the PPARS system, which went out of control. When the ESRI came forward with its analysis of the cost of the particular model of universal health insurance we had proposed to introduce, this Government said clearly we will not introduce that particular model because it would be too costly.

Micheál Martin (Cork South Central, Fianna Fail)
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The Taoiseach is chancing his arm.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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This question is being stretched too far.

Enda Kenny (Mayo, Fine Gael)
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The Government remains very committed to a model of universal health care that will provide patients with affordable, quality care at all times. That service will be funded through a different model of universal health insurance from what was originally proposed. Building on the reforms that are already in place, we will continue to move away from the wasteful, inefficient and unfair approach to health service provision we inherited some years ago. Moreover, it must be done in a way that is affordable to both taxpayers and the buyers of health insurance. Deputy Martin is well aware there are different models of universal health insurance and that the ultimate cost of insurance to families and the Exchequer depends upon the nature and type of model chosen and the level of subsidy to be provided by the State. The Government commissioned the ESRI to examine the financial implications of implementing a particular model of universal health insurance based on data from 2013, a time when health budgets had been cut significantly and systems had not been put in place to control costs more effectively. The high costs for health insurance customers estimated by the ESRI are not acceptable either now or at any time in the future. The ESRI report vindicates the Government's decision not to rush into the implementation of that particular model of universal health insurance.

Micheál Martin (Cork South Central, Fianna Fail)
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Did the Taoiseach use the word "rush"?

Enda Kenny (Mayo, Fine Gael)
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Indeed, it is clear from the ESRI report that the foundations are not in place to meet the Government's original timeline of introducing universal health insurance by 2019. Those foundations include sufficient capacity to satisfy unmet demand and the provision of enhanced primary and social care. The introduction of free GP care for under sixes and over 70s has been done seamlessly and is very much welcomed by the people who are benefiting from it. The next move as part of that strategy is to provide free GP care to the children of all working families. We also intend to put in place reformed structures to replace the HSE with hospital groups and trusts, community health care organisations and other new structures. I look forward to the implementation of those hospital groups, under which the contracts for medical personnel will be with a group rather than an individual hospital and where the groups will have the capacity to evolve into trusts which will be able to make the decisions that reflect what they consider to be the best options for their hospitals in the years ahead. We intend, too, to introduce financial reforms and advance the Healthy Ireland and public health and patient safety agendas.

When all of those measures are completed, we will be able to compare the advantages and disadvantages of a number of funding options for universal health insurance. It is true to say that reform in the past was rushed and, as a result, serious mistakes were made, such as with the construction of the HSE in 2005. The intention of Government is to continue to provide a better health service for the Irish people and carry out further research on the models of universal health insurance, how they can be funded and what the subsidy should be. The decision on the exact nature of the model will be made by the next Government and implemented in the term after that.

Gerry Adams (Louth, Sinn Fein)
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Will the Taoiseach clarify whether the Cabinet committee on health met six times or eight times?

Enda Kenny (Mayo, Fine Gael)
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The committee's last three meetings were on 13 July, 29 September and 2 November. There have been eight meetings in the year to date.

Gerry Adams (Louth, Sinn Fein)
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I thank the Taoiseach. We are not allowed to discuss the business of the committee, but I am concerned with getting a handle on how it does its work and holds the Government to account. The Government's position on health, or at least what was outlined to us, was that we would see free GP care for all, an end to prescription charges, universal health insurance, abolition of the Health Service Executive, an end to trolley waits and an end to two-tier waiting lists. There were more details given but those are the highlights of the Government's health policy. One presumes the Cabinet committee on health meets to deal with all of these matters. Surely, in the course of its deliberations, it would have discussed the fact we have not seen free GP care for all, an end to prescription charges, universal health insurance, abolition of the HSE or an end to trolley waits. In fact, in November, the month in which the committee last met, the Irish Nurses and Midwives Organisation revealed there was a 4% increase in the numbers on trolleys, the figure being 7,407 admitted patients, and a 24% year-on-year increase, the total figure being 87,000 admitted patients.

That is a Croke Park full of citizens on trolleys. Of 29 emergency departments, 25 have increased overcrowding. Today, there are 401 citizens on trolleys, 27 of them in Our Lady of Lourdes Hospital in my own constituency. We also have 2,000 fewer nurses. The Minister is making public statements, which include, for example, the proposal that hospital groups should be able to conduct business in the manner of semi-State companies, outside the constraints of public service rules. He also says he is going to scrap the universal health insurance plan because it could not work and it never could have worked. This Government has created chaos in the health service because its firm ideological position is not to have a universal public health service, but to privatise it and to have a for-profit system, as revealed by the Minister, outside the constraints of public service rules.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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I will have to take the Deputy back to the question.

Gerry Adams (Louth, Sinn Fein)
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My instinct is to ask the Taoiseach - it will be ruled out of order, but I will ask him anyway - whether the committee considered any of those matters. The Taoiseach once talked, famously, about having a report card. As we approach the end of the year, if this committee had a report card, how would he mark it up? No free GP care for all, no end to prescription charges, no universal health insurance, no abolition of the HSE, no end to trolley waits and no end to two-tier waiting lists. Behind those statistics are, as I raised last week, the case of Denise and Jake Tuohy or Orlaith, a five week old baby girl. I am sure every Teachta Dála could raise equally poignant cases. I have already said to the Taoiseach previously in this type of discussion that I am not against this type of focused approach on co-ordinating the necessary priority at any given time, but surely this Cabinet committee on health, in its eight meetings, has not justified its own existence?

Enda Kenny (Mayo, Fine Gael)
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Deputy Adams spoke about the report card. The report card for Ireland reads of many things: unemployment down from 15.2% to 8.9%, employment up by 135,000-----

Gerry Adams (Louth, Sinn Fein)
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Two thousand fewer nurses.

Enda Kenny (Mayo, Fine Gael)
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-----interest rates down from 15% to less than 2%-----

Gerry Adams (Louth, Sinn Fein)
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Half a million people across the globe.

Enda Kenny (Mayo, Fine Gael)
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-----the deficit will be below 1% next year, the national debt is falling rapidly, confidence is rising, new companies are being formed, and people are returning home to take up jobs. The more people we have working, the less tax each will pay and the greater the engine we will have to invest in the provision of services, including in health.

Gerry Adams (Louth, Sinn Fein)
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Why has the Government not done it?

Enda Kenny (Mayo, Fine Gael)
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Sinn Féin's report card says abolish water charges, abolish property charges, increase income tax, drive down disposable income and drive jobs out of the country. The question the people will face in the spring-----

Gerry Adams (Louth, Sinn Fein)
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Yes. They are smarter than the Taoiseach thinks.

Enda Kenny (Mayo, Fine Gael)
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-----the central question for the Irish people, which will be the most important question to be answered for a very long time, is who they believe can keep this recovery going in the interest of the people.

Gerry Adams (Louth, Sinn Fein)
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A fair recovery.

Enda Kenny (Mayo, Fine Gael)
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Is it Sinn Féin's operation, which will increase income tax, drive jobs out of the place, drive down disposable income and assume that people will say "Of course, abolish all the property charges, abolish all the water charges, abolish everything else, and pay for nothing"?

Gerry Adams (Louth, Sinn Fein)
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Answer the question, for God's sake.

Enda Kenny (Mayo, Fine Gael)
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Deputy Adams mentioned the nurses' strike. I believe-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Hold on a second. This is about a Cabinet sub-committee. It is not about-----

Gerry Adams (Louth, Sinn Fein)
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He has not even talked about health in his answer. He is neglecting the whole area.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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There are other questions and I want to move on

Gerry Adams (Louth, Sinn Fein)
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He is at the church gate.

Enda Kenny (Mayo, Fine Gael)
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The INMO has given notice of strike action to take place in Beaumont Hospital, the Mercy Hospital in Cork, Tallaght hospital in Dublin, Cavan General Hospital, University Hospital Waterford, the Midlands Regional Hospital in Tullamore and Galway University Hospital on Tuesday, 15 December. I hope this can be avoided. It should be possible for health service management and the INMO to reach agreement on the key issues. Industrial action will not solve any problems. We have shared objectives: the delivery of patient care and the health and well-being of nursing staff working in the emergency departments.

Negotiations took place on Thursday at the Workplace Relations Commission and they are continuing until tomorrow. All parties are committed to intensive engagement in these negotiations so that a solution can be reached. If it is not reached by the close of business tomorrow, management will seek further talks on Thursday so that a comprehensive contingency plan can be put in place.

There are plans in place to deal with emergency department overcrowding. The numbers on trolleys are now down by 20% on the same period last year for each morning and the focus has to continue to be on working hard together to implement that plan. The Government recognises that bed capacity has to be increased. We have put in place related measures to make that happen, including an additional 450 beds, 129 of which were closed before and an additional 326. To date, 200 have been opened, with the rest to open over the next few weeks. I hope people can sit down and talk rationally about this in the interests of both the quality of facility the nurses have but particularly for the patients in their care. They do a very good job.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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Is it not a fairly stinging indictment of the strategy and work of the health sub-committee and of this Government's policy on health that the nurses, who want to care for people, feel forced to go out on strike next week because of the utter disaster in emergency departments? Is that not just about the most serious indictment one can have? Today, according to Trolley Watch, there are 411 people on trolleys across the country, suffering that indignity when they should be in beds.

It is interesting that the Taoiseach uses the word "recovery". The 50,000 people who are waiting over a year on waiting lists to get into hospitals will not be recovering from the real physical pain or ailments they are suffering from because of an utterly unacceptable situation. Some people are waiting far longer than that. I am dealing with several cases of elderly people who have worked all their lives and who need hip replacements. It will take 18 months, but that is after they have managed to get a consultant's appointment to get on the list. In reality, people will have to suffer chronic pain for two and a half years. This situation is getting worse. There is no recovery for them, just pain. They cannot believe, when they hear the Taoiseach talk about recovery, that this is the reality they are suffering.

This sub-committee, in its strategy to resolve the mess that is our health service, has failed disastrously because the Government pursued this notion of universal health insurance, which it has now accepted is a fantasy that will never materialise. Those of us who said from the beginning that the health insurance model for solving the crisis in our health system was always going to be expensive and would not work have been vindicated. What we have asked all along is for the Government to look at the National Health Service single-tier model, as the most effective way to deliver healthcare for everybody. It does not involve the profit-taking of private health insurance companies or private for-profit interests essentially sucking money and resources out of a health service. What we need is a not-for-profit universal national health system. That is how we will deliver the desperately needed healthcare to people on those lists and end the indignity of people sitting on trolleys for hours and days in our hospitals every day of the week.

Enda Kenny (Mayo, Fine Gael)
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I might say to the Deputy that-----

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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We are not having a broad discussion now in the House on this, please.

Enda Kenny (Mayo, Fine Gael)
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-----a great deal of progress is being made. The Government provided €51.4 million to deliver on the Minister's target of maximum waiting times of 15 months by the year end, and significant progress is being made. As of 3 December last, a total of 23,924 outpatient appointments and 3,549 inpatient or day case procedures are required to achieve the 15-month maximum waiting time by the end of December, that is, 27,473 in total. To put that in context, on 12 November 2015, the equivalent numbers were 39,374 for outpatients and 7,231 inpatients or day cases, or 46,605 cases in all.

The moratorium has been lifted and very significant numbers of nurses and medical personnel are employed now who were not employed last year. For instance, the number of applications for registration of nurses received at 1 July last was 974 and 1,841 at 31 October. That was an increase of 223% in July 2015 over the same period in 2014 and an increase of 139% in October 2015 over the same period in 2014.

The moratorium being lifted allows for the recruitment of professional nurses. In fact, I was speaking to a young graduate nurse the other day who had just qualified from UCD.

Gerry Adams (Louth, Sinn Fein)
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Had the Taoiseach two pints with her?

Enda Kenny (Mayo, Fine Gael)
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She made the point to me that, of the 200 nurses who qualified, 150 had been offered permanent employment in Ireland, which is a big change from what applied previously. Of the other 50, most, being young people, wanted to go to different countries for a number of years. I thought that the point she made, as one of 150 young professional nurses employed in hospitals throughout the country, was a significant expression of modern youthful enthusiasm to assist in the work of giving patients the very best care and attention.

While Deputy Boyd Barrett naturally will say that everything is deplorable, there is a great deal of beneficial activity going on. The Minister secured substantial funding over past year and we hope to continue the improvement.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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It does not explain why they are going on strike.

Enda Kenny (Mayo, Fine Gael)
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It is the firm intention of Government to work towards the implementation of a single tier system to eliminate the inequitable two-tier system which has been around for many years. This new system is to be funded by universal health insurance but not the model that Government set out with the intention of implementing in the first place because it has been proven to be too costly for families and those who would buy health insurance in the first place.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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We are now moving on to Question No. 7.

Micheál Martin (Cork South Central, Fianna Fail)
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Can I ask a brief supplementary?

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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No. Those questions were about when the Cabinet health committee met. We have gone over the whole track of the health service and I am moving on now to Question No. 7.

Micheál Martin (Cork South Central, Fianna Fail)
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I would make the point that somebody who tables a question gets the same treatment as somebody who does not even bother tabling one.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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The three Deputies had questions tabled.

Micheál Martin (Cork South Central, Fianna Fail)
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I do not think Deputy Boyd Barrett did.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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He did. Let us get this straight. Deputies Higgins, Martin, Adams and Boyd Barrett had questions-----

Micheál Martin (Cork South Central, Fianna Fail)
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Okay, I had two questions.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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-----and everybody got a chance.