Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
Link to this: Individually | In context | Oireachtas source

3. To ask the Taoiseach when Cabinet committee E, health, will meet next. [51725/18]

Brendan Howlin (Wexford, Labour)
Link to this: Individually | In context | Oireachtas source

4. To ask the Taoiseach when Cabinet committee E, health, last met; and when it next plans to meet. [52101/18]

Mary Lou McDonald (Dublin Central, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

5. To ask the Taoiseach when Cabinet committee E, health, last met; and when it is scheduled to meet again. [53030/18]

Joan Burton (Dublin West, Labour)
Link to this: Individually | In context | Oireachtas source

6. To ask the Taoiseach when Cabinet committee E, health, last met. [53142/18]

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I propose to take Questions Nos. 3 to 6, inclusive, together.

Cabinet committee E last met on 22 November 2018. A date for the next meeting has not yet been scheduled. In addition to the meetings of the full Cabinet and Cabinet committees, I often meet with Ministers and their teams on an individual basis to focus on particular issues. In this regard, I regularly meet with the Minister for Health, Deputy Harris, to discuss issues relating to our health service.

The Government’s continuing commitment to improve access to health and social services for the people through investment across community and hospital services is reflected in the significant increases in health investment in recent years. This year will see the highest ever level of health funding in the history of the State. We have also committed almost €11 billion in capital investment over the next ten years through the national development plan and Project Ireland 2040, which is approximately double what was invested in infrastructure in healthcare in the past ten years.

The recently published national service plan sets out in detail the level of health services to be provided by the HSE within the available funding for the coming year. It outlines the provision of a range of Government initiatives including mental health enhancements, disability services, cervical screening, the HPV vaccine for boys, the introduction of termination of pregnancy services and the merger of the three children’s hospitals in Dublin into Children’s Health Ireland, which took effect on 1 January. Primary care enhancements include provision for funding for a new general practitioner, GP, contract should negotiations on it be successful, reduced prescription charges, reduced drug payment scheme charges from March, an increase in the GP visit card thresholds from March and the initiation of a programme of care redesign in line with Sláintecare.

The service plan emphasises the importance of strengthening clinical leadership, improving patient and service user engagement and advancing a culture of patient safety, continuous quality improvement and learning. To ensure meaningful and sustained improvement in the health service over the coming years, however, we also need to develop a major programme of reform. The new Sláintecare programme office has prepared a detailed action plan for 2019 as committed to in the Sláintecare implementation strategy and I expect it to be published shortly. A Sláintecare advisory council has also been established under the chairmanship of Dr. Tom Keane. These new structures will drive implementation of the reform programme.

Budget 2019 provides for more than €200 million directly to assist a range of initiatives proposed in the Sláintecare report and committed to in the implementation strategy. Work is also under way to establish a new HSE board to strengthen the management, governance and accountability of the HSE. Mr. Ciarán Devane has been nominated as chairperson-designate of the board.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
Link to this: Individually | In context | Oireachtas source

It is extraordinary to listen to the Taoiseach's answer on the health service: one would think everything is improving. We are facing industrial action by thousands of nurses from the Irish Nurses and Midwives Organisation and the Psychiatric Nurses Association of Ireland. Incredibly, the Taoiseach's Cabinet committee on health has not met since November despite facing industrial action by the nurses. When he comments on the matter, he seems intent on criticising the nurses for taking industrial action. He fails to recognise, however, that Government policy has produced this crisis and forced nurses into a position where they feel they must take industrial action. He continues to peddle the myth that there is no retention problem for nurses, but the truth needs to be said. For every four nursing vacancies, there is only one application. Some 5% fewer nurses work in the health service than did in 2008, while the number of managers has increased by 40%.

Nurses are earning €7,000 less at every point of their career than similar graduate professionals working in the health service. The Taoiseach touts pay increases which are actually restoration of cuts that his party proposed and that remain not fully restored ten years after the austerity assault on public sector workers, including nurses, was launched. He does not acknowledge that nurses give up an hour and a half for free to the health service, or the costs resulting from overcrowding, waiting lists and cancelled operations because there are not enough nurses to staff the hospitals. Rather, there are myths about the cost of what nurses are demanding, despite €2 million a week being paid to agency nurses and overseas recruitment firms being paid €10,000 per nurse recruited because the Government will not directly employ staff nurses. All the costs of cancellations in the health service result from chronic staff shortages which in turn result from our failure to recruit enough nurses or retain them because the Government will not pay them properly. Will the Taoiseach face up to the reality of what is going on, talk to nurses, listen to them and concede to their just and legitimate demands?

Brendan Howlin (Wexford, Labour)
Link to this: Individually | In context | Oireachtas source

I return to the issue of the overrun on the cost of the national children's hospital, which the Taoiseach answered in general terms earlier. He said he thinks the current estimate, that is, on 15 January, is the same as it was before Christmas, but in the past number of weeks there has been further speculation that it has risen from the staggering €1.4 billion, which he indicated to the House before Christmas, to €1.7 billion, although even that might not be the height of the cost.

The Taoiseach talked about the 15 operating theatres and all the rest of it. We know what this really good hospital will comprise. In my political career I have never seen a project so completely out of control in terms of cost. Even the expanded cost, which was originally €450 million but more realistically €650 million, is now likely to be three times that figure. How can that be? How did that come about? What are the factors? The Taoiseach indicated earlier that it was an issue of construction inflation. Construction inflation does not triple the price, otherwise every single project under construction right now would be triple the price of the estimate, which is not the case. What are the specific reasons? Why was this not drawn to people's attention before the end of last year in a very public fashion?

Finally, the Taoiseach indicated that €100 million of cuts would be required across the public sector capital programme this year and that €50 million of this would be in health. He more or less said it would just delay projects. People are urgently waiting for dialysis units to be constructed as well as facilities in hospitals up and down the country. Delays are really having an impact. Many school projects will be affected as a result of the €50 million to be found elsewhere. Some €100 million is a really significant sum of money. Can the Taoiseach indicate exactly where that €100 million will be found and give the House a real explanation as to how this particular project has completely gone off the rails in terms of cost oversight?

Pearse Doherty (Donegal, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

In the same vein, the response of the Taoiseach earlier that this will be the best hospital and will last for 100 years is fine and great. We need the hospital and nobody objects to that but the issue here is the runaway cost. He described this project back in 2014-2015 as spectacular, and it will be spectacular when constructed. He said it would cost €650 million and would be fully operational this year. It will cost three times that and will not be fully operational for many years to come.

There are serious questions and we deserve answers as to how the Government got this so wrong. The Taoiseach will criticise others and will throw cheap shots but he was the Minister for Health. His colleague is the Minister for Health and he is the Taoiseach who told us that he was going to take a special role and interest in this. Every euro in terms of additional cost that will go into building this hospital will be taken from other public services, whether a school that will not be built, a community hospital that will be delayed or an extension to an existing hospital that will be delayed or put on the long finger. These are the concerns people have about this.

The Taoiseach tries to dismiss this as if everything is okay but this is a throwback to the Fianna Fáil era of calculations on the back of the brown envelope. If one closed one's eyes, one could pretend one was not talking about the national children's hospital but about the Dublin Port tunnel or one of the other capital projects Fianna Fáil continued to allow developers to benefit from in this State. The Taoiseach told us that would not happen with his Government and we expected it would not. Now that it has happened, he expects us just to ignore the fact these costs have increased to such a degree and expects us not to look for accountability.

There are serious questions in different communities. For example, in the Midland Regional Hospital in Mullingar, there are serious concerns that the MRI scanner that was part of Project Ireland 2040 will not be delivered as a result of the overruns in health. Are these the types of capital projects that will be cut or delayed? There is a responsibility on the Taoiseach, who has made such a cock-up of this over the past number of years, to explain to the public where the axe will fall? Which projects will be cut because his Government and his Ministers took their eye off the ball and did not ensure value for money on this project?

Joan Burton (Dublin West, Labour)
Link to this: Individually | In context | Oireachtas source

I was very upset, like many people, when I read that parents who have not completed meningitis vaccinations for their children will not be afforded a free vaccination but instead will be charged €200. For instance, if they have three children, which many parents have, who have not completed the vaccination cycle, this will amount to €600. That would wipe out many families on social welfare or on a minimum wage income. At the same time the Minister for Health announced a Department of Health variation of the strategic communications unit, that is, a public relations exercise fee of €75,000. Has the Taoiseach, his Minister or his Government any sense of how to address priorities in the Department of Health? Meningitis is a serious public health risk and it is a serious abuse of public funds not to ensure that children at risk are properly vaccinated and that those vaccinations are performed as a public health service.

I refer to the cost of the children's hospital which people are baffled by. The Taoiseach was in that seat at a very important time for that project. I was delighted to see the Taoiseach visiting Africa last week but if anybody from Europe went to a small or a large African country and was told by aid officials that a children's health project - for example, building a large children's hospital - was potentially running €1 billion to €2 billion over the estimate in the plan would immediately suspect that such a cost overrun was due to misappropriation or some form of corruption of the process.

The Taoiseach is here to provide the Dáil with answers as Leader of the Government. Can he explain these conundrums in the Department of Health under his command as Taoiseach?

Micheál Martin (Cork South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

At the outset, there needs to be an Oireachtas inquiry into the escalating cost of the children's hospital. The Taoiseach said earlier that when he was Minister for Health he thought it would cost €650 million. Yet in a couple of years, it has gone up to apparently to €1.7 billion, according to a Cabinet memorandum that was evidently given to The Irish Times. This was given days after the Taoiseach told me it was €1.4 billion. It seems the Dáil is the last place to be told anything in detail. I asked the Taoiseach in the last session of the Dail whether that the upper limit and, to be fair, he did not say it was but he did not use the figure of €1.7 billion, which is in the memorandum. The Irish Timesgot this memorandum from somebody, and it must have been someone in government, and it published it and a lot of material on this. To go from €650 million to €1.7 billion in approximately two years demands detailed explanation. We all know the Department of Public Expenditure and Reform keeps a tight rein on capital projects and it is meant to do so and there are procedures and mechanisms for that. It is not enough to say that a hospital group has been given carte blancheto do and spend anything it likes. That is not the way it works and I hope that was not what was being suggested earlier today in the answer to a substantive question asked by another Deputy during Leaders' Questions. There needs to be an Oireachtas inquiry of some sort and there should be full accountability as to how it has jumped from €650 million to €1.7 billion.

On the issue of the meningitis B vaccine, I am perturbed as to how that is being introduced. I happened to be the Minister for Health when the meningitis C vaccine became available and we did a full programme that cost €50 million at the time, most of which was a once-off cost because it was dealing with all children. There was no hesitation about that at the time given the expert advice. The Department of Finance accepted at the time that it had to be done on public health grounds.

The meningitis B vaccine was not ready at the time and the advice was that the impact of meningitis B could be potentially worse than meningitis C. There needs to be a very serious review of how the meningitis B vaccine is being rolled out because of its devastating impact on children and young people generally when the illness occurs.

I could raise many other issues, but I do not have the time. I ask the Taoiseach to comment on the article by Susan Mitchell last weekend on Sláintecare in which she said the hospital groups would be broken up and merged into regional integrated care organisations, RICOs. In a speech in November 2015, the Taoiseach heralded the hospital groups as central to reform. Has that changed, and does he now support the proposals to abolish them at the start of the Sláintecare project?

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I spoke earlier on the threatened nurses strike and the Minister of State, Deputy Jim Daly, answered the question on meningitis B so I will use my time to answer questions that have not been answered.

Brendan Howlin (Wexford, Labour)
Link to this: Individually | In context | Oireachtas source

The Taoiseach could answer the question we asked him.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
Link to this: Individually | In context | Oireachtas source

The Taoiseach could answer the question I asked him.

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Deputy Boyd Barrett said that listening to me one would imagine that everything was fine in the health service, but I do not think that for a moment. Listening to him, one would think absolutely nothing at all is going right. Let me tell him about some of the things that are going right. The waiting times for operations and procedures in hospitals – hips, knees, eyes, cataracts and angiograms – are now at their lowest in five years.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
Link to this: Individually | In context | Oireachtas source

What I asked is why the Taoiseach thinks the nurses are going on strike.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
Link to this: Individually | In context | Oireachtas source

Will the Deputy please allow the Taoiseach to respond?

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Cancer survival rates are improving, stroke survival rates and heart attack survival rates are improving. Suicide rates are going down while life expectancy is increasing. None of that has happened by accident. It has happened because the right policies and strategies have been put in place by the health service. They have been funded by the Government. It has also happened because of the professionalism and hard work of all of our healthcare staff.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
Link to this: Individually | In context | Oireachtas source

That is why the nurses are going on strike.

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

No, I was just talking about patients.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
Link to this: Individually | In context | Oireachtas source

My question was about the strike.

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I noted in Deputy Boyd Barrett’s lengthy speech on this issue that he did not mention patients at all.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
Link to this: Individually | In context | Oireachtas source

I did.

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

For me, patient outcomes should be at the centre of our concerns when it comes to the health service.

Pearse Doherty (Donegal, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

The Deputy did.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
Link to this: Individually | In context | Oireachtas source

I mentioned patients.

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

If the Deputy did, it was fleeting because I did not hear it.

I did not read Susan Mitchell's report but I have read the Sláintecare document, which recommends that we move towards integrated healthcare structures rather than the current system of hospital groups and community healthcare organisations. Hospitals will be combined with community services as part of the Sláintecare reforms.

Brendan Howlin (Wexford, Labour)
Link to this: Individually | In context | Oireachtas source

Another structure.

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Sláintecare recommends structural change.

Brendan Howlin (Wexford, Labour)
Link to this: Individually | In context | Oireachtas source

That is the fifth.

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

People are very quick to criticise the Government for not implementing it but when we do, we are criticised as well. Either one is for Sláintecare or one is not. Sláintecare recommends this reform, namely, that we move towards integrated healthcare structures again.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
Link to this: Individually | In context | Oireachtas source

The ESRI recommended paying the nurses but that was ignored.

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

In terms of the rising costs of the children's hospital, my assessment is that the costs were underestimated in the first place but construction inflation has had a significant impact. Changes also had to be made to the sprinkler system-----

Brendan Howlin (Wexford, Labour)
Link to this: Individually | In context | Oireachtas source

It is a very expensive sprinkler system.

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

-----and the cost of the electrical engineering system in particular was much higher than had been intended.

Micheál Martin (Cork South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

It could cost €1 billion.

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

The Department of Health is inquiring further into the issue. The National Paediatric Hospital Development Board, which is the dedicated State agency set up to deliver the hospital, is available to come in and answer questions in detail. It will have the financial people working on the project do that at the Joint Committee on Health.

Micheál Martin (Cork South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

So should the Minister.

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

He is happy to do it too.

Micheál Martin (Cork South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

So should the Ministers and the Taoiseach.

Pearse Doherty (Donegal, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

The Taoiseach was also Minister for Health.

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

We are happy to do it too.

Brendan Howlin (Wexford, Labour)
Link to this: Individually | In context | Oireachtas source

The Minister has statutory responsibility for the matter.

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I am sure the Minister for Health will be asked all of these questions as well.

There are other health projects under way, including the new national rehabilitation hospital in Dún Laoghaire, for example, and the new national forensic mental health hospital in Portrane. As things stand, those projects look like they are going to come in on time and on budget.

Micheál Martin (Cork South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

The Taoiseach should be careful.

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I accept that may change but for context, let us at least bear in mind that other national hospitals are being built-----

Micheál Martin (Cork South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

That could mean they are definitely going up.

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

-----which are coming in around budget.

In terms of the reprofiling or delays that may happen to other projects, that is still being worked out by the Department of Public Expenditure and Reform. We believe we will be able to do it in the context of a €5 billion capital budget for this year, which is 25% higher than last year, by reprofiling projects rather than cancelling them. As Deputy Howlin will know from his time profiling expenditure, on occasion one finds that another project does not get planning permission or it runs into problems with the tender and that can create savings but that has not been determined yet.