Health Budget Crisis

Fianna Fáil Leader Micheál Martin questions the Taoiseach on the crisis in the health budget

Deputy Micheál Martin: Following yesterday's meeting of the Committee of Public Accounts, we learned that the health budget was in severe crisis.  At the end of August the overrun was reported as being in the order of €329 million.  By September it had increased to €374 million and is now projected to end up at €500 million by the end of the year.  It was RTE which told us last evening that Tallaght hospital had to apply to Allied Irish Banks for an overdraft of €12 million, with a letter of comfort from the HSE.  This was not mentioned at yesterday's meeting of the Committee of Public Accounts.  Furthermore, the CEO-designate could not confirm whether the HSE had been consulted or involved in the selection of the additional primary care centres.  We deduced from his reply that officials had nothing whatsoever to do with the added centres selected by the Minister for Health, Deputy James Reilly.

We also know that Tallaght hospital is not the only one with a massive deficit.  Across the country acute hospitals are in dire financial straits, which is having an impact on patients, staff and the broader economy.  We have raised these concerns about health overruns since last April and were told by the Taoiseach in this House that everything was under control.  We all know where that has ended up.

Deputy Micheál Martin: Promises made on health savings have not been achieved.  This has resulted in extra cuts to home help services, for example.  More than 1 million home help hours have been severed from families around the country.  That is the reality.  Are we facing cuts of a similar order across the acute hospital service?  The CEO of Tallaght hospital could not confirm on radio this morning that there would not be further cuts.  I am asking for a degree of transparency and honesty on this issue.

What is the Government hiding?  What is the HSE hiding?  Why is the Department hiding very basic facts that the people are seeking?  The Minister for Public Expenditure and Reform, Deputy Brendan Howlin, sought the facts three months ago in a letter to the Minister, Deputy James Reilly, when he told him to get personally involved in sorting out the budget.  The House would like to know what are the implications of the overruns for patient services.

Will the Taoiseach at least allow a full presentation by the Minister for Health to the Dáil on the financial crisis in the health service in order that we can be told, openly and honestly, what the Government's approach will be in dealing with the crisis?  If the Minister is willing to take suggestions from across the House, such an engagement would facilitate this, but we must at least have openness and a transparent approach to the budget.  Second, will the Taoiseach ensure, in accordance with what the Tánaiste told me last week, that all documentation on the primary care centre sites is published once and for all in order that we can get to the bottom of what happened and discover why a particular site in Dublin was moved from an open-lease arrangement to a public private partnership?  All we are asking for is this basic information.

The Taoiseach: Deputy Micheál Martin has raised a number of issues.  It ill behoves him to come into the House as somebody who served in the Department of Health-----

The Taoiseach: We are not going to hide behind the wreckage the Deputy's party left behind.  We will not hide behind the litany of failures he epitomised in that Department or the litany of consultants' reports he commissioned and did nothing about.  The Government was appointed and elected to serve the country.  The HSE was a completely dysfunctional organisation.  Squashing the health boards together and imposing the superstructure of the HSE on top was supposed to provide the best world-class service right across the health system.  However, the Minister for Health found that there was no effective management, no effective financial control and no clear accountability in terms of the programmes being implemented.

The Taoiseach: What is happening is the start of a generational reform of the health system.

Nobody ever said the system would be transformed in the space of 12 months.  We understand it is a major undertaking, affecting people all over the country.  I listened this morning to the financial director of Tallaght hospital as she set out very clearly an example of what could actually happen here.  This is a hospital which had an extraordinary overrrun in its budget but has managed the situation in such a way as to ensure more people are seen more effectively and a better service is given.  While its budget has been cut, it still has made savings.  The financial director clarified beyond "Yea" or "Nay" that nobody needed to have any worry that he or she would not receive the best level of hospital attention.  Tallaght hospital is one of a number, the hospital in Galway being another, which are leading the way.  Every hospital wants to be in the same category.

When it comes to the health service, it is not a case of despair, as presented by Deputy Micheál Martin in this House every day.  Tallaght hospital is an example of a facility which has made bold decisions in the interests of the effective running of the hospital, decisions which are of paramount importance in terms of patient treatment.  Tallaght hospital was approved, in accordance with the regulations, for an overdraft until the end of the year.  The actual overdraft of €4 million was cleared, as was clarified this morning, in January this year.  Tallaght hospital achieved significant operational savings in 2012 and reduced its year-on-year spending by 6%, despite having to contend with a 5% increase in inpatient numbers and a 9% reduction in its allocation for this year.  It is an example of a hospital transforming itself into what we want it to be.  The financial director has pointed out that by 2014 management expects to be where it wants to be and where it knows it can be.

Issues that have been raised and are being dealt with by the Minister for Health include decisions regarding consultants, the reform that is taking place in respect of the drugs bill and a range of others which are under consideration.

Tomorrow, I will meet the Minister for Public Expenditure and Reform, Deputy Brendan Howlin, and Croke Park agreement implementation group.  The Minister and I expect to discuss with the implementation group other issues that will bring about a reduction in the overall pay bill.  I do not accept Deputy Martin's bleating or the histrionics in which Deputy Sean Fleming engaged at yesterday's meeting of the Committee of Public Accounts, which was a disgrace to any public official.  It is about time Deputy Martin reflected on the reason he did not show some of the anger, curiosity and inquisitiveness he is showing now when he was in charge of the Department.

Deputy Micheál Martin: I asked the Taoiseach two questions and he did not answer them.

It is par for the course with him that he does not answer questions and instead filibusters.  He avoided answering the two basic questions I asked him.  I asked if, in terms of the budget overrun, he would facilitate an open and transparent debate in the House during which the Minister for Health would give a full presentation on the crisis in the finances of the health service.

I do not know whether the Taoiseach has chose to ignore the problem or whether the Government is in denial about it.  I am not inventing the figures; they were provided yesterday, formally and officially, and paint a picture of a problem that has been getting worse from the beginning of the year.  The reason is the Minister for Health introduced a budget 12 months ago that was built on sand and was dishonest and flawed.  He has allowed the problem to escalate to the current extreme position in which there was an overrun of up to €374 million at the end of September.

Will the Taoiseach ensure such a debate is held in the House?  A concerted attempt is being made to hide information and prevent it from coming out.  It is prevalent across the Government and has been reflected in committees, especially the Committee of Public Accounts, on a number of issues recently.

To return to the second question, will the Taoiseach ensure all documentation related to the selection of primary care centres is published?  Will he answer with a "Yes" or "No"?  Why would he not answer that simple question?  Why would he not release the documentation?  Will he publish all of it, including that related to the additions made to the list of primary care centres?

The Taoiseach: The answer to Deputy Martin's first question is "Yes".  I have already made perfectly clear to the Deputy and other Deputies that there will be an open debate on the financial circumstances the country faces.

Deputy Micheál Martin: I am referring to health.

The Taoiseach: All the Deputy wants to do, week after week, is have individual Ministers in the House making statements.  May I finish my point, please?  The Deputy asked me a question.  The week after next, the House will discuss the economic situation the country faces as we prepare for budget 2013.  Part of that discussion is to allow for contributions from everybody and anybody on health and every other matter.  The Minister for Public Expenditure and Reform wrote to the chairpersons of each of the Oireachtas select committees, including the Select Committee on Health and Children.

Deputy Micheál Martin: He also wrote to the Minister for Health.

An Ceann Comhairle: I ask the Taoiseach to ignore interruptions and speak through the Chair.  Deputy Martin should remain silent please.

The Taoiseach: In his letter, the Minister stated that a central theme of the reforms, as set out in the Government programme, is the need to strengthen the role of the Oireachtas, in particular, the Dáil select committees in their important task of scrutinising the proposed allocation of public funds and making a more timely and effective contribution to national budgetary and resource allocation policy.  I hope that statement is clear.  It is part of the programme for Government and an invitation to have each sector, including health, discussed in detail by the Oireachtas committee set up for that purpose.  Instead of walking out, Deputy Martin and any of his representatives can ask all of the questions they wish at the Select Committee on Health and Children, including questions on information related to primary care centres or any other matter they may wish to raise.

Deputy Micheál Martin: I asked for a debate on health.  Will the Government publish all the documentation on primary care centres?  Why can we not have a debate on health in plenary session?  We are we not getting answers?  Will the Government publish the documentation I seek?