Leaders’ Questions 02.10.12

Deputy Micheál Martin: Since we last spoke in the House, the Minister of State at the Department of Health, Deputy Shortall, has resigned.  She gave a very revealing interview on the Marian Finucane radio show at the weekend in which she confirmed everything we have been saying in this House over recent months about work on primary care being blocked and poor management of the health budget, so much so that we are now facing the most appalling cuts because of the Minister's failure to tackle these issues.

The Taoiseach might recall that I asked three weeks ago whether the delegation of ministerial orders had been laid before the House on the former Minister of State's functions.  The Taoiseach did not seem to know if they were or not and said he would get back to me.  I checked and they were laid before the House in September 2011.  What is most revealing is that while they cover medicinal products and the poisons Bill, among other things they excluded completely any reference to primary care.  Despite appointing the Minister of State, Deputy Shortall, saying she would have special responsibility for primary care, there is not a mention of primary care.  Was it not then the Taoiseach, the Tánaiste and their Cabinet colleagues ditched and isolated the Minister?  She was not given statutory delegation for primary care and despite knowing from freedom of information requests that she had sought it on a number of occasions, it fell on deaf ears.  Who excluded primary care from her delegated statutory authority as Minister of State?

The Minister of State met the Tánaiste and the Taoiseach during the summer to resolve this issue, and the suggestion was that a summer holiday might sort it out.  We know the Minister of State had deep reservations about the Minister's performance that went beyond the added primary care centres.  They went to the core of the implementation of the programme for Government itself.

Deputy Micheál Martin: As for the added primary care centres, the Minister, Deputy Reilly, has changed his story repeatedly.  He misled the Dáil last week by claiming that Balbriggan and Swords lost out and were swept from high priority to low priority.  There was no prioritisation system in 2007, as the former Minister of State, Deputy Shortall, has confirmed and as have others close to the issue.

Originally, the Minister, Deputy Reilly, stated that he consulted ministerial colleagues and officials, but no ministerial colleague can be found to confirm that he or she was consulted.  Several Ministers, namely, Deputies Varadkar, Burton, Quinn and Creighton, have stated they are not familiar with the details.

Can the Taoiseach spell out the criteria?  Can he confirm that he actually approved of the addition by the Minister, Deputy Reilly, of those 15 centres and of the basis on which he did it?  Moreover, I presume the Taoiseach will facilitate the Minister's appearance before the House today to make a statement and to answer questions in this regard given that he is doing so with the Fine Gael Party.  Moreover, I note the new Minister of State, Deputy White, also has been asked to find out the details relating to the criteria.

The Taoiseach: When Deputy Martin asked me the question last week about the statutory instrument, I could not recall exactly the nature of the instrument or when it was laid before the Dáil and I promised to revert to him.  He is aware that all statutory instruments refer to a legal base.  There is no legal base to a primary care Act, so in terms of statutory instruments they refer specifically to narrower confines.  However, primary care, no more than public transport or any other issue, covers a range of activities.

I can confirm to Deputy Martin that the position is that issues which were raised in recent days about the pharmaceutical industry and the cost of drugs, insurance claims and the issue concerning consultants being re-rostered and the substantial savings that will accrue over the coming years have all been the focus of pretty intense negotiations with conclusion in areas of these in the past period and with more to come.  In respect of the primary care centres, when I addressed this matter last week, I told Deputy Martin they were in different sectors, in that leases were involved in some, direct Exchequer funding was involved in others and, in some cases, the primary care centres would be provided under a public private partnership, PPP, system.  This is all part of the stimulus package of more than €2.5 billion brought forward by the Government which covers the areas of transport, health, justice and education, as well as the major development at Grangegorman.  The entire seamless package was announced by the Minister for Public Expenditure and Reform and, obviously, was approved by the Government.

From his own experience, the Deputy is aware of the value of primary care centres and how fundamental they are to providing a proper health system and health structures nationwide.  I have visited a number of such centres myself, including one in Deputy Calleary's native town, which is very efficient and competent.

It has had the highly beneficial consequence of not having numbers turning up to accident and emergency centres who do not need to go there.  More primary centres are needed and what has been announced by the Minister for Public Expenditure and Reform is but part of the requirements that are needed in this regard.  There will be more to follow because more are required.

Deputy Micheál Martin: The Taoiseach did not answer any of the questions I asked.  I do not buy his answer in respect of the statutory order.  However, I asked him specifically whether he approved of the adding of the 15 centres.  This pertains to public private partnerships, which, as I noted last week, have a strong commercial dimension to them because they involve the State entering into a contract with individuals, a company or an entity.  Therefore, there must be a transparent and open process.  It is almost equivalent to a tender situation.  It is a commercial contract.  Consequently, one cannot simply fudge it and this has been a major problem since this issue first arose.  Moreover, the story keeps changing all the time.  The Taoiseach might indicate what 15 sites were displaced by the 15 that were added, given the list that Deputy Shortall had put together.  The more I consider this saga from the outset the more I am reminded of a poem by Francis Duggan, "One Lie Leads To Another Lie So Happens To Be True", which goes:

When you tell one lie it leads to another

So you tell two lies to cover each other

Then you tell three lies and, oh brother

You're in trouble up to your ears.

I would never apply that to the Cabinet and so on but that seems to be the position in respect of this saga.

Can the Taoiseach confirm the Minister, Deputy Reilly, will come into the House to make a statement?  Is that the position?  There has been a request by the Opposition but I am unsure whether it has been acceded to.  Unquestionably, however, given all the different versions Members have heard on this matter, given that Fine Gael is having a meeting to discuss it and given that the Minister of State, Deputy White, has been sent in by some of his Labour Party colleagues to find out the reason they were added, the least one can expect is for Dáil Éireann to have an opportunity to get a clear, honest and truthful account of how the 15 sites were added.

The Taoiseach: While I am unsure from what shelf in his archives the Deputy withdrew the poet's lines perhaps before producing it here in the Chamber, he might have reflected on the fact that people on his side of the House stated "I didn't know the IMF was here; it is not here".

Moreover, he appeared on many television screens around the world on his travels stating that there was no need for a bailout and that it would be preposterous for Ireland.  He should not come into this House and lecture Members with a poet's words.  The fact of the matter is that to put together a proposal for primary care centres, be they where leases were involved, where direct Exchequer funding was involved or the PPP system one actually needs more than the number one sets out to put in place because one would not wish to be subservient to vested interests.

Deputy Micheál Martin: But there already was a list.

The Taoiseach: One would not wish to be caught in a situation where, for instance, general practitioners would not buy into using the facility.

Deputy Micheál Martin: Yes, but there already was a list beyond the 20 sites.

The Taoiseach: Consequently, the proposal is to have 20 primary care centres under the PPP system.  However, if one states they are the only 20 the Government intends to put in place, anyone could refuse to buy into that and therefore, one does not get the results one seeks.

Deputy Micheál Martin: One follow the rankings as per the system.

The Taoiseach: The Minister has outlined to the House the reasons for expanding the criteria beyond deprivation only.

They are also to provide for competition, to provide for dealing with potential vested interests-----

Deputy Micheál Martin: They were his criteria and his alone.  There was a very interesting parliamentary question and reply last week.  The civil servants are not going with it.

The Taoiseach: -----to deal with problems that arise with objections in certain locations and so on.  I think Deputy Martin can agree that primary care centres are a fundamental part of the changing of the structure of the delivery of health services.

I have seen them myself and they are operating exceptionally well.  I hope the process that is under way to bring to a conclusion the provision of these 20 primary care centres, for which a great deal of development is needed before they become a reality, will result in the provision of those centres of excellence and in confidence for people in those locations.

Deputy Micheál Martin: Is the Minister coming before the House?

The Taoiseach: They will become a reality out of the 35 sites.