Dáil debates

Thursday, 5 May 2022

Ceisteanna ó Cheannairí - Leaders' Questions

 

12:00 pm

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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We now move to Leaders' Questions. I ask that all Members adhere to the rules laid down regarding the time allocated for each question.

Photo of Pearse DohertyPearse Doherty (Donegal, Sinn Fein)
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Ardóidh mé inniu an úinéireacht atá beartaithe don ospidéal náisiúnta máithreachais agus atá molta ag an Rialtas agus ag an Aire Sláinte. In ainneoin na himní tromchúisí atá curtha in iúl ag go leor ban agus go leor dochtúirí faoi athlonnú an ospidéil go dtí suíomh Ospidéal Naomh Uinseann i mBaile Átha Cliath, tá an Rialtas ag leanúint go dícheallach leis an rogha léas a bheith aige ar an talamh ar a dtógfar an t-ospidéal in áit a bheith ina úinéir di. Ní dhéanann sé ciall ar chor ar bith go mbeidh píosa iontach tábhachtach dár mbonneagar sláinte a thógáil ar chostas thar €1 billiún ar talamh nach mbeidh úinéireacht ag an Stát uirthi.

I wish to raise the proposed ownership model of the national maternity hospital being pursued by the Government and the Minister for Health. Despite serious concerns being voiced by many women and many prominent medics about the relocation of the hospital to the site at St. Vincent's University Hospital in Dublin, the Government is relentlessly pursuing the option of leasing the land on which the hospital will be built instead of owning it outright. It is very concerning that the deputy chairperson of the HSE board, Professor Deirdre Madden, a leading medical law scholar, and Dr. Sarah McLoughlin, a patient advocate on the board, both dissented from the board's decision to recommend the legal framework.

Everyone in this House agrees that a new national maternity hospital needs to be built and become operational as soon as possible but expedience cannot be at the cost of rights in any way. The full range of legally permissible services must be available in the hospital to any qualifying patient. The minutes of the HSE board meeting of 14 March show that Professor Madden and Dr. McLoughlin expressed concerns at the "legal ownership of the site and building, and the governance and control of the proposed new maternity hospital" and felt that these concerns were not adequately addressed in the revised legal framework.

It does not make any sense that the Government is going to build a vital piece of health infrastructure at a likely cost of approximately €1 billion on land the State does not own. The Taoiseach said yesterday that the lease would only cost €10 per year but that does not change the fact that the new hospital will have a private landlord. The question must be asked once again, because no answers were forthcoming on this issue yesterday from the Taoiseach, as to why the Sisters of Charity and St. Vincent's University Hospital cannot simply gift the land to the State. It is a simple question. What is the answer? Why is the Government accepting this convoluted, messy ownership model that is stoking unease and worry? What we need is a publicly built maternity hospital on publicly owned land delivering public healthcare services for women at a standard of excellence. Sin é. That is what is required. This would protect the State's investment and address the concerns of so many who fear that religious dogma could compromise the delivery of healthcare at the hospital.

We understand from media reports that, among others, the Minister for Tourism, Culture, Arts, Gaeltacht, Sport and Media raised concerns about this model at Cabinet. It is incumbent on the Minister for the Environment, Climate and Communications to give a full answer as to why the Government continues to pursue a model of ownership that does not enjoy the confidence it should. Will he outline his position? Is he satisfied with this model of ownership despite the fact that the land will not be owned by the State?

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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The Minister for Tourism, Culture, Arts, Gaeltacht, Sport and Media was asked these questions yesterday. As she rightly stated, what we decided at Cabinet on Tuesday is that it would be very good for us to have this debate in order to have full scrutiny and transparency with all the legal documents because people on all sides and from various different parties are concerned. It was right and appropriate for us to make the decision that the Minister for Health would go before the Joint Committee on Health and answer every question in order that every possible angle of this matter might be examined. I fully agree with the Minister for Tourism, Culture, Arts, Gaeltacht, Sport and Media in this regard.

There are very different medical views on this matter. The Deputy quoted one medic versus another. The vast majority of medics and the wider public recognise that the existing situation in the National Maternity Hospital, as good as that facility is in terms of medical care, is intolerable and that we cannot delay. The Master of the hospital attended our parliamentary party meeting yesterday and said that even if we went out and commenced work tomorrow, it would be 2030 before we would see a new hospital in operation at St. Vincent's. Any further delay that would put matters back five, ten or whatever number of years, as we started to look at alternative options, would give rise to real controversy.

My view is that the legal documentation and the various structures show that there will be no religious interference, which was one of the main concerns I have heard over the years in respect of this matter. This is clear and transparent. A good article in The Irish Timestoday states that legal experts think that if religious interference were allowed, those responsible would rightly be accused of medical negligence. There are legal structures in place to give reassurance in that regard.

The issue of how this hospital will operate is a much wider in nature and relates to our voluntary health and voluntary hospital systems. All three maternity hospitals in Dublin are voluntary hospitals, with structures that in some cases go back over 200 years. There is a debate separate to the religious issue as to whether we should engage in compulsory purchase of those hospitals and move away from a voluntary hospital system. There is an argument to be made in that regard, but it has not formed part of the debate to date. Another article in today's edition of the Irish Independentrefers to the fact that the voluntary hospitals are the ones that are currently providing the full range of services, whereas not all public HSE-run hospitals do. This is a complex and difficult issue in terms of the strengths and benefits of voluntary hospitals versus HSE-run hospitals. Our voluntary health system has real benefits

My view is that the national maternity strategy should be central to this because it provides the guiding direction. The strategy gives me real reassurance and we need to apply it because it recognises that even with the voluntary hospitals, hospital group CEOs will ultimately be accountable to the national director of acute hospitals for all services delivered within the maternity network. That is an important point. This is where the actual direction comes from. What is that direction? It is for a woman-centred system that is midwife-led rather than consultant-led, with much more care in the community. This is what we need to focus on delivering at St. Vincent's, Holles Street, the Rotunda, the Coombe, Limerick and every other maternity hospital. That is the guide as to where we should go and how services should be developed and delivered.

Photo of Pearse DohertyPearse Doherty (Donegal, Sinn Fein)
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The Minister did not answer my questions. I asked why the Sisters of Charity and St. Vincent's cannot gift this land to the State. It is as simple as that. From what the Minister said, it seems that he supports the idea of spending €1 billion of taxpayers' money building a hospital that we all agree is needed on land that is not owned by the State. Does he agree with the statement that I have not heard a single dissenting voice from anyone who does not believe that the hospital must be in complete public ownership? That should involve not the creation of a lease arrangement but, rather, the transfer of ownership of the site to the State so that there is no uncertainty or lack of clarity regarding ownership. These were the Minister's words in opposition. The difference is that now he has some power to do something about it. It should not involve the creation of a lease arrangement but rather the transfer of ownership of the site to the State so that there is no uncertainty. The Minister previously said that the State needed to step up. It is time for him to step up. Deputy Hourigan was on the radio yesterday saying that this is an incredibly serious issue. She said it went to the core of why people voted for the Green Party. Has the Minister abandoned the position he held, which was that a lease agreement was not acceptable and did not provide the certainty or has he now rolled over to the tune of Fine Gael and Fianna Fáil?

12:10 pm

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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The original approach in terms of how this would be structured was set out in the Mulvey report in 2016. The Government has changed what was set down somewhat. The lease arrangement was originally for 149 years; it is now for 300 years and will cost €10 a year. It is my understanding that the Sisters of Charity were asked if they wanted to sell the land. Their response was that they did not want do so. My understanding is that they are no longer in the business of healthcare. The St. Vincent's Healthcare Group has decided, as is its right, to retain its voluntary hospital status and operate this co-located model. The change made by the Government is that rather than just St. Vincent's and the National Maternity Hospital having board members, there will be three public interest members, and the Minister will appoint the chair. As stated, we have changed some aspects of the arrangement.

Photo of Pearse DohertyPearse Doherty (Donegal, Sinn Fein)
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It is still a lease.

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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The underlying argument in favour of co-location remains. There are good reasons for this, including ensuring the provision of good medical care for women. Patients should be able to go from one ward to the another; from the maternity hospital to the general hospital.

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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Will the Minister answer a question? Why is it beyond the capability of this Government - and why was it beyond that of the two previous Fine Gael-led Governments - to countenance a State-owned and controlled national maternity hospital, built on State lands and through the use of State funds? The Minister once agreed that this was the only credible outcome. In 2017, he told the Dáil that the new maternity hospital "should involve not the creation of a lease arrangement but rather the transfer of ownership of the site to the State so that there is no uncertainty or lack of clarity on the ownership". Has he changed his mind in that regard? Does he, like the Taoiseach, believe that a lease agreement is practically the same as ownership, so what is the big deal? Is it only the future of women's healthcare services that is on the line and, of course, a €1 billion investment of public funds. The Taoiseach made a big thing of the €10 annual rental charge yesterday. Tellingly, he failed to mention that the actual rent stipulated in the lease agreement is €850,000 per year. It will be reduced to €10 as long as list of six conditions are complied with, including that the landlord, St. Vincent's Holdings, retains a controlling stake over the use of the hospital. If these conditions are breached, the rent will revert upwards. If St. Vincent's Holdings is magnanimously offering an annual rent of €10, can the Minister explain why this punitive penalty clause exists? It is especially bizarre that a separate legal document - an options agreement - specifically countenances the State purchasing the site. If everyone agrees that it is legally feasible that the State could buy the site, and that outcome is expressly provided for in legal documents, why is the State not just buying the site?

There has been a lot of talk about conspiracy theories in recent days, with those who have genuine concerns about this deal being vilified and equated almost to anti-vaxxers or Covid deniers. This is something I personally find pretty reprehensible. If we want to talk about conspiracy theories, I have a better one. An article in The Irish Timestoday suggests that the Minister of Health has 100% guaranteed that terminations and sterilisations will be available in the new hospital, a guarantee which, as reported by the media, could be relied on in legal proceedings as evidence of the Government's intention concerning the hospital. That is nonsense. The only thing that a court will have regard to is the legal documents underpinning the deal. A Minister's guarantee, unless it is contained in the legal documents, is worthless.

I have two questions. Why, when the Minister, Deputy Ryan, once insisted that the State should own the site, is he apparently happy to go along with this deal? Second, is the rest of his party in agreement with him?

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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As I said in my response to the question from Deputy Doherty, my understanding is that the Government and that which preceded it did approach St. Vincent's to see if it would be possible to purchase the land outright. The hospital group decided that it, as a voluntary hospital, wanted to run with the arrangement involving Holles Street and the new board . That arrangement has changed, with public interest directors being added to the board. With St. Vincent's saying "No" and with real benefits in a co-located system, the question that arises for the Government is what to do. Do we look for another hospital or another co-location facility, recognising that we are probably going to have the same issue with the Coombe and Rotunda in time, because the strategy is to move towards the model where our maternity hospitals are co-located? There are benefits in that regard. We are agreed on that. Therefore, the choice for the Government is whether to turn down a 300-year lease at €10 a year, which is akin to ownership. There is not a material difference between outright ownership and a 300-year lease at that rate. It is better to progress with that, because there is an urgency around delivering combined health services, rather than going back to the drawing board and waiting the five, ten or 15 years that it tends to take this State, unfortunately, to deliver principal health systems. We have not built a new maternity hospital probably since the Coombe in the 1950s or Holles Street in the 1930s. I cannot think of another instance of one being built since then.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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The Mercy hospital in Cork was built after that.

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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Sorry, the Mercy hospital in Cork was built. We do not build a lot of maternity hospitals, and we are incredibly slow at delivering them. We need to deliver. A 300-year lease gives us the reassurances that we need. The legal structures give real assurance against the risk of religious interference, which, I understand, has been a real concern. I believe that matter has been addressed. In my mind, doing nothing, walking away and deciding not take that option would not be the right approach.

We look forward to the debate at the Oireachtas committee this week and to hearing what the alternative approach is, how we can avoid delay and how we might move forward in another way. I do not see another way. It is important that we act.

Going back to the key point - and I hope the Deputy, as one of the people involved in bringing forward the Sláintecare report, agrees with this - I see the national maternity strategy as being centrally connected to it. Does the Deputy agree that the focus needs to be not only on who owns the hospital but also on how we get a midwife-led, woman-centred maternity system in place? I do not believe that we have delivered the maternity strategy with the pace and the ambition that is required. That is where the focus needs to be. It is not just about whether a 300-year lease constitutes effective ownership. That is not the key issue for the women of this country. We need to focus on the care.

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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The Minister is being quite disingenuous. This project has been delayed for almost a decade. Four successive Ministers for Health were incapable of delivering the project in a way that would satisfy the public in terms of the independence of the hospital and the protection of a massive public investment. The Minister referred to co-location. Nobody argues about that. This is about so much more than co-location, however. It is about a takeover. Does the Minister realise, because I do not think he does, that the new national maternity hospital is due to become a wholly owned subsidiary of St. Vincent's Holdings? Its status is to change completely. Furthermore, we all know that the Vatican had to approve the nuns' transfer of their shareholding to the new holding company. When asked what terms and conditions were attached to this transfer and whether any documentation exists spelling them out, the Minister of Health flippantly responded that we would have to talk to the Vatican about the matter and that the Government does not have any such documents. Is the Minister, Deputy Ryan, seriously telling us that that question has never been asked in the context of that delay? If it has not been asked, why is that the case?

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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With regard to the status of the institution, the other people I have listened to, including women friends, colleagues, those who are connected to the hospital and clinicians-----

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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Did the Minister read the document?

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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Please, Deputy. The Minister is responding.

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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I am trying to read every single document.

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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Is it acceptable------

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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Can I just make the point-----

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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Is it acceptable that it will be a wholly owned subsidiary?

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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Deputy, let the Minister answer the questions already asked.

Photo of Darragh O'BrienDarragh O'Brien (Dublin Fingal, Fianna Fail)
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She is not interested in answers; she never has been.

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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I wish to make the point that it seems to me that the vast majority of clinicians in the existing hospital are arguing very strongly that we should proceed.

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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Of course, because they want a new hospital.

12:20 pm

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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If the Deputy is saying that the institution is deeply worried about the loss of its independence or that St. Vincent's will be taking it over, I do not hear that from the clinicians in Holles Street.

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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Did they have access to the legal documents?

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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I will get back to the key point I want to make. It is not just the conditions. Under the national maternity strategy, it is the national director of acute hospital services who will have ultimate accountability and that is important to remember.

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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It is St. Vincent's Holdings that will control the national maternity hospital.

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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It is the State-----

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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Read the documents.

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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-----and State policy that will decide how this is run.

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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The current documents; not those from a few years ago.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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Can we please let the Minister who is asked questions answer without interruption?

Photo of Darragh O'BrienDarragh O'Brien (Dublin Fingal, Fianna Fail)
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The Deputy is not interested in answers; never has been.

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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I am, you know.

Photo of Darragh O'BrienDarragh O'Brien (Dublin Fingal, Fianna Fail)
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You are not.

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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I am. I would love it if you were.

Photo of Darragh O'BrienDarragh O'Brien (Dublin Fingal, Fianna Fail)
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You are interested in controversy; that is all.

Photo of Catherine ConnollyCatherine Connolly (Galway West, Independent)
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It would be helpful for us on this side if the questions were answered and with a little less heckling from the colleagues to the right of the Minister, Deputy Ryan. I am not one bit reassured. I welcome the pause, but I am deeply troubled that at the same time there is a pause that will allow the committee to look at it we have reports in The Irish Times, a newspaper of repute, telling us that the Government has no intention of changing any of the documents. It is as if the Government is seeking to calm the masses. I will look at the Minister's point on the existing hospital. The conditions are intolerable but I ask the Minister to please not use up the reply telling me that. On this side of the House, we have repeatedly called for the hospital to be co-located on a site owned by the public and run by the State. What is equally intolerable is the failure of the Minister, the Taoiseach, the Tánaiste and the Minister for Health to deal with any of the issues we are raising today.

Deputy Shortall raised the issue of rent and the Minister conveniently ignored it. Even with my background, I am struggling to read through the documents we got. I look at those documents and I see there is a 299-year lease and a provision for rent. As has been alluded to by Deputy Shortall, the documents set out the position regarding rent. The Minister might explain that further and outline what will be the default position when the higher rent comes into being if the conditions are not met. The Minister might apologies for saying that the delay is on our side when the delay has consistently been on the side of the St. Vincent's Healthcare Group and the Religious Sisters of Charity. The Minister might explain how the gift we were going to get never materialised. He might also explain, as Deputy Doherty asked, why we cannot have the site given over to us in our name.

I have struggled with these documents. I can see no reason for all this complexity. If we look at the senior counsel's opinion that was commissioned by Uplift, it states: "Insofar as ownership of the lands are not obtained, the proposed arrangements are Byzantine in their complexity, almost Kafkaesque". In 2020, Dr. Peter Boylan, in the context of the ownership, was informed by the National Maternity Hospital's lawyers that there would be a plethora of different structures and ownerships and a complexity to the legal documents. The Minister is telling us today that the situation is intolerable in the hospital. I agree. What is equally intolerable is the Government's failure to deal with the serious concerns we are raising, that Dr. Boylan has raised and that the two dissenting and very distinguished members of the health executive board raised. That is not to mention the women and men of Ireland who are concerned and the three motions unanimously passed by this Dáil asking for public ownership of the hospital.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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Hear, hear.

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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In the context of the report on the front page of The Irish Timestoday, the Cabinet decided on Tuesday to: open up all the documentation; make sure it was fully transparent; allow the Oireachtas committee to examine, question and investigate; and for the Minister for Health to come back to the Cabinet with observations from that process. That is what was decided at Cabinet. We will have to wait and see what will be decided at Cabinet in two weeks time. It is not decided on the front page of an Irish newspaper.

No one on our side, in our party or, certainly, from what I have heard, in government is casting blame for the delay or saying it was one side or the other. From listening in recent years, it seems that the central concern relates to religious interference in procedures in a new institution. One of the outcomes of the delay that has occurred in recent years is that there is a clear legal certainty that this will not be the case and that those concerns can be allayed and addressed.

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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Where is that certainty?

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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In the constitutional arrangement, the framework and all the legal analysis and documentation. I refer back to another article in The Irish Timestoday which states that various independent legal experts were asked if they think there is still a concern in that regard. From what I read, the vast majority of those which expertise in the area of medical legal matters stated that should no longer be a concern. It was important that this was addressed.

This matter is complex. It is complex because the charters and rules of governance of Holles Street and the Rotunda Hospital date back to when they were founded 200 or 300 years ago. Trying to bring together one of these institutions with a voluntary hospital organisation is difficult. Our voluntary structures are strange. Let us be honest about that. If you were designing a system from the start, would you design it along the lines of our complex Irish health system which has these effective, flexible and capable voluntary hospital systems? Probably not. We have those systems, however. What would happen if we were to compulsorily purchase the entire voluntary health sector or another sector?

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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Maybe debate that first.

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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I am just asking the question because it would involve is a debate on a wider matter. Catherine Day carried out her analysis and compiled a report on how we might manage that. I am of the view that it can be managed and that we can retain a voluntary health system that will be a public health system that will Sláintecare-based and that puts communities first. It should not all be led by and centred on hospitals and consultants. That change needs to come.

This new institution will not answer, solve or change all of those issues. We need it to be built. We also need to ensure that its buildings, etc., will be much better than those in which people in Holles Street are operating at present. For that reason, I look forward to going back to Cabinet in two weeks to hear what has been said at the committee and to make a decision on the matter. Further delay would not be the right choice.

Photo of Catherine ConnollyCatherine Connolly (Galway West, Independent)
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Let me try to clarify the position in 60 seconds. The Government is open to change; is that what the Minister said?

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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I did not say that.

Photo of Catherine ConnollyCatherine Connolly (Galway West, Independent)
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So the Government is not open to change. That is very good. We have that clarified. My concerns are in respect of the documents I have read and the absence of some extremely important documents, such as, for example, as the constitution of the St. Vincent's Healthcare Group. Mr. Menton tells us that the group is evolving into a secular organisation. Evolution is slow and I would like to know where we are in the evolutionary process of the St. Vincent's Healthcare Group. Where is it as a secular organisation?

The Minister mentioned complexity. There is no complexity here. This is the 21st century. On the basis of what has happened in our history, which I do not have time to go into, we have to have a national maternity hospital on a public site.

On the documents that are missing - in addition to the constitution I have mentioned - I would like to know on what basis the Religious Sisters of Charity was finally happy to give over its share. How did the Vatican allow the order to do that and still comply with its ethics and so on? It is difficult to get that information. This matter needs to be the subject of proper debate here in the Dáil.

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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I am familiar with St. Vincent's University Hospital. It is my local hospital and many of my family and friends have been treated there.

Photo of Catherine ConnollyCatherine Connolly (Galway West, Independent)
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I am asking the Minister for specifics.

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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Can I answer the question?

Photo of Catherine ConnollyCatherine Connolly (Galway West, Independent)
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Certainly. Please do.

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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The Deputy asked me about the nature of its secular values or its-----

Photo of Catherine ConnollyCatherine Connolly (Galway West, Independent)
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I asked the Minister if the Government is open to change, and he said it is not.

Photo of Colm BrophyColm Brophy (Dublin South West, Fine Gael)
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How can the Deputy say we are heckling?

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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I will try to answer if I can.

Photo of Catherine ConnollyCatherine Connolly (Galway West, Independent)
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I apologise.

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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The Deputy asked me how we can be sure that the ethos of St. Vincent's is secular. That is one of the questions she asked. One of the analysis documents I read today looked at its objectives or mission statement. Whether they is religious or secular, the values referred to in that document are ones we would all agree on. They are not two separate or completely different worlds. The values the hospital wants to deliver - I have seen it deliver them - relate to valuing and protecting life, the Hippocratic oath and treating patients with fairness and equity. As I understand it, that is outlined in the hospital's mission statement.

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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No birth control.

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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It is secular, but that does not mean it is completely divorced from the past because it has often done a lot of that.

I have seen first hand the incredible care that it provides to the patients. We need to make sure that the skills it has are also available to the women in the national maternity hospital not an ambulance ride away but in a corridor beside it. That is why this approach is being taken.

12:30 pm

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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For the information of the House, the Business Committee agreed this morning that there will be a debate in the House next week on this matter. Next week also, the Oireachtas Joint Committee on Health will hear a presentation from the Minister at which we hope all the questions Members have will be dealt with.

Photo of Michael Healy-RaeMichael Healy-Rae (Kerry, Independent)
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I am glad the Minister's colleagues are here, especially the Minister for Housing, Heritage and Local Government, a person for whom I have high regard. Mr. Michael O'Flynn, the highly-respectable building contractor and developer of more than 40 years' experience, said in an article in The Irish Times by Mr. Ciarán Hancock last week, and which should be compulsory reading, that the lack of zoned land was at the heart of the housing crisis. That is down to poor planning. Politicians need to get over the mistakes of the past and start talking to and listening to the people who have experience in home building, that is, the developers who are left and have ability.

There are people here who are talking and talking and have never and will never build a house. Last year, the O'Flynn Group completed 480 homes. Mr. O'Flynn said that the reduction of VAT in building is vital. Developers are overpaying for land in a race to get sites. The national framework is flawed in that it is based on the premise that 40% of all developed land should be brownfield but it needs to be viable and affordable. If a proper economic assessment of that policy was done, it would be clear that it is not possible for that brownfield land to be developed without subsidisation or incentives.

Nothing can be developed, unless it is viable. The fast-tracking of planning through the system of strategic housing developments was good but has now become mired in legal reviews and is being replaced instead of being improved. We are throwing out the legislation and that is incorrect.

The banks at present in Ireland are not fit for purpose. People cannot get loans. Homeowners or those who want to be homeowners, small builders and medium-sized and larger groups cannot get access to money. AIB is continuously putting up signs to say it is backing brave. It should be made take down those signs because they are stupid and very annoying for people who are being taken to hell and back begging for money and loans. They are in the bank looking at this sign saying AIB is backing brave. AIB would not know what brave was if it hit it in the face.

We need to zone more land and to reduce the 13.5% VAT rate. We need to reform planning to reduce delays. We need to loosen the Central Bank of Ireland mortgage rules to allow people to borrow four and a half times their income rather than the current three and a half times. In the past, land prices were 10% of the house cost. Now they could be 30%. VAT in the past was 3%. Now it is 13.5%. A shared equity scheme would not be needed if the Government was not taking so much VAT in the first instance. People think-----

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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The Deputy's time is up.

Photo of Michael Healy-RaeMichael Healy-Rae (Kerry, Independent)
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I just have this point.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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Time is up.

Photo of Michael Healy-RaeMichael Healy-Rae (Kerry, Independent)
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People think that the builder pays the VAT. The builder does not. The VAT is paid for by the end user; the person buying the house.

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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I do not agree with the Deputy that the shortage of zoned land is the cornerstone of the housing problem. I also do not agree with him about cutting the likes of tax, VAT and so on. That would just go to the developers rather than the householders. The Housing for All strategy the Government is delivering is the right approach to tackling this. Central to it has to be the national planning framework. At its core are three key objectives: better-balanced regional development, more compact development and low-carbon development.

The first objective of better-balanced development is very important. I go around country to talk to different councils. I was in Limerick, Cork and Waterford and will be going to Galway shortly to listen what is actually happening on the ground. I spend time with the councillors to hear what is really happening and about what is being zoned and built and about what is not happening. We are still not sufficiently following the guidance of the national planning framework. Too much of the housing is still in the greater Dublin area. We need housing in Cork, Limerick, Waterford and Galway, in particular, but also in towns and villages throughout the country in order that we get a better-balanced spread.

Photo of Peadar TóibínPeadar Tóibín (Meath West, Aontú)
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They need jobs though.

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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That is not against Dublin but Dublin is under such pressure at the moment because so much of the development is happening on the east coast. We need better-balanced regional development.

That will not happen in Cork, Limerick, Galway or Waterford just by zoning ever-outwards which has been the characteristic of development. It will happen by the measures the Minister, Deputy O'Brien, is introducing with the State intervening not just in social housing but also through the Land Development Agency. Development happening around Colbert Station in the centre of Limerick is a very good example of how we are under-using land in the centre. It is not a shortage of zoned land. It is a shortage of good planning and good strategic thinking. The benefit of the compact approach where one goes back to the centre is that it is by nature low carbon. We do not have to keep building out new water and other infrastructure.

That is another key element of what I have learned by going round the country listening to councils. Clare is an example. Why is it that we are not building new housing in those 51 or so perfect towns and villages in Clare that are ripe for development and where we have the schools, the church and the pub? It is because we need to ramp up Irish Water and its investment in the infrastructure within existing towns and villages that would help us to deliver houses in those areas.

The sort of funding that the Minister, Deputy O'Brien, is providing helps to provide some of that infrastructure. In cases where developers cannot make a business case for it, the State directly invests to support some of the projects getting built. That is the way of tackling it, and not by going down the road of zoning everything. That is what happened in the 1980s, 1990s and 2000s and got us into a housing crisis. It was a developer-led approach. We do not need to do that. We need a plan-led approach with the State in a central role working with developers rather than for them.

Photo of Michael Healy-RaeMichael Healy-Rae (Kerry, Independent)
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I would not expect the Minister to agree with me because I am right. Builders small and large and developers large and small are needed to fix the problem. It is not the people in government or in opposition talking and talking who will do anything good. However, we need to make the policies. We need to get the policies right. What we have done is put regulation on regulation and red tape on red tape to make it impossible for people to build and make it sensible to do so.

It is like doing away with bedsits. If bedsits in Dublin or any other part of Ireland were up to a proper standard and were affordable for people to live in for a period of time, what would be wrong with them? Absolutely nothing. People realise that now after doing away with them in the first instance.

Mistakes were made in the past but now we have to move on. I say to the Minister, Deputy Ryan, the Minister for Housing, Local Government and Heritage, and everybody in government that without a functioning property industry, they will not have a proper, functioning economy.

We have to get over and realise that wrong things were done by politicians and developers in the past but we now have to listen to and work with the people who are in that industry for us to solve this problem for once and for all. In regard to us to be ashamed of-----

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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Time is up.

Photo of Michael Healy-RaeMichael Healy-Rae (Kerry, Independent)
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-----or to be slow about saying we are talking and engaging, we have to talk to these people who have expertise. We have to listen to and work with them.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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We have to hear the Minister because the Deputy is out of time.

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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The Housing for All strategy is the right approach and it is starting to deliver results. In the first quarter of this year, my understanding is that some 6,000 houses were completed, built and delivered. In the year to February of the previous year, there were 35,000 commencements. It is not enough and we need to get better-balanced regional development to get more housing in other parts of the country than the east but it is working. We have some control over it because it is State led. We are putting in significant resources and giving real direction to councils and developers throughout the country.

It is at a critical moment in time. Most of the councils are in the middle of their development plans. Deputy Michael Healy-Rae will know that, as I am sure it is the same in Kerry as everywhere else. I stand up in this process for the Office of the Planning Regulator because his office has the right vision and the job to guide those councils to make sure we do not free fall where every council is trying to get as much zoned land as possible. Instead, we need to be strategic and use sticks as well as carrots to make sure that idle land and vacant sites are developed. That is what we will do.

12:40 pm

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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I noticed Kerry was not on that list of counties the Minister has visited. Perhaps Deputy Michael Healy-Rae will invite him to the Kingdom.

Photo of Darragh O'BrienDarragh O'Brien (Dublin Fingal, Fianna Fail)
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I have been there.

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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I am looking forward to going to Kerry in June. I will look forward to calling to Kilgarvan or any place in the county.

Photo of Michael Healy-RaeMichael Healy-Rae (Kerry, Independent)
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The Minister will be welcome and I will send him to the bog for the day.

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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We might go out-----

Photo of Michael Healy-RaeMichael Healy-Rae (Kerry, Independent)
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I will knock a bit of the te-spock out of him.

(Interruptions).

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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The turf will all have been footed by that stage anyway.

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
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Sure he can load it.

Photo of Michael Healy-RaeMichael Healy-Rae (Kerry, Independent)
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The weather will be good.