Leaders’ Questions 25.09.12

Posted on 25/09/12 by Micheál Martin

Deputy Micheál Martin: The Minister of State at the Department of Health, Deputy Róisín Shortall, teams from the HSE and the Department of Health and the Minister for Health, Deputy Reilly, agreed an objective set of criteria, internationally recognised, relating to urban and rural deprivation to be used in selecting primary care centres.  They decided to select 20.  However, behind the back of the Minister of State and parallel with all of this, the Minister seemed to have a different thought process entirely.  After consulting Cabinet colleagues, he took a unilateral decision to add a further 15 to the 20, including two in his constituency.  He published no criteria or provided no evidence base to justify this unilateral decision.

Public private partnerships have a significant commercial dimension.  They involve general practitioners, allied health professionals, therapists and so forth.  For this reason, above and beyond anything else, there must be objective criteria, fairness and transparency because various interests and consortia are entitled to bid and tender for such centres and projects.  Is it appropriate that a Minister should ride roughshod over existing agreements and criteria and take decisions unilaterally which can benefit private sector interests?  These are multi-million pound ventures with profit as a desired objective.  There is nothing wrong with making a profit, but that is the key ingredient in this issue.  It is equivalent to tendering, which is the reason Ministers should be at one remove from such decisions.  Did the Minister know at the time of his decision who the preferred bidder for the Balbriggan site was?  Was this disclosed?

The Minister for Transport, Tourism and Sport, Deputy Leo Varadkar, has described this as stroke politics.  Others have described it as naked clientelism, but I am saying it is more than this.  The commercial private sector dimension is significant, which is why the Minister is wrong in the decision he took.  Does the Taoiseach agree that the Minister's actions were inappropriate and unacceptable?

The Taoiseach: Primary care development is a fundamental part of the strategy to reform the health sector.  Clearly, primary care centres have enormous capacity to take people in, rather than having them go to accident and emergency units in the first place.  Given the range of facilities that can, should and will be provided in primary care centres, they are important.  There were broader criteria used than just the deprivation index in the selection of primary care centres.  The criteria also included the impact on acute services in hospitals, competition and GP co-operation.  The Minister and the Department of Public Expenditure and Reform accepted that competition was required to ensure there would be a cost-effective GP buy-in and on that basis the number of potential primary care centre locations was determined.

It is important to note that this is part of the overall stimulus package announced by the Minister for Public Expenditure and Reform some time ago, which included expenditure in the areas of road development, schools and primary care centres.

Each of these sectors was approved by the Government following consultations by the Ministers involved with their colleagues, and the same applied in this case.

It is also important to note that early this year the HSE set out its prioritisation for primary care centres.  Deputy Martin will be aware that in some locations the HSE was already at advanced stages of discussion about the development of primary care centres, including the leasing of premises by GPs for primary care, and this was deemed the most appropriate way of delivering those centres.  A number of other high-priority locations were selected for direct investment by the HSE using Exchequer funds from the HSE's capital allocation, and the remaining locations were then considered as being appropriate for public-private partnership development.

Deputy Martin will be aware that if one wishes to develop 20 primary care centres and one selects only 20 possibilities, one runs the risk of objections, non-buy-in by GPs, lack of competition and other factors.  What the Government approved and signed off was a list of 35 primary care centres, with 20 to be developed.  That does not mean that the first 20 will actually be developed, because of the factors that I mentioned.  In order to get this moving as quickly as possible, taking into account situations in which there were leases involved, an intention to lease, direct Exchequer funding or PPPs, the Minister, in consultation with his colleagues, made a recommendation to the Government and the Government signed off on that element of the stimulus package for the development of 20 primary care centres from a list of 35.

Deputy Micheál Martin: We found all of this out through freedom of information requests and from the media.  We found out nothing from the Government.  In fact, the last parliamentary question that the Minister, Deputy Reilly, answered in May stated that urban and rural deprivation was the clear criterion.  He said nothing about anything else, and we have received no documentation from the Taoiseach or the Minister about broader criteria.  That was not an honest reply.  The Taoiseach needs to be honest and transparent with the House in this regard.

What is clear from all of this is that the Minister of State, Deputy Shortall, plays by the rules, while Deputy Reilly does not.  What is equally extraordinary is the degree to which the Labour Party hierarchy was willing to isolate Deputy Shortall to protect Deputy Reilly, and all in the name of deprivation.  That is why Deputy Shortall stood her ground.  Deputy Shortall's letter to Deputy Reilly gives the lie to what the Taoiseach just said.  She wrote that when she met the Minister, Deputy Reilly, to discuss primary care policy on 29 February 2012, they agreed, and subsequently minuted, that "the provision of centres should be informed by needs analysis, with priority given to areas of urban and rural deprivation".  Her letter goes on to mention the universal primary care team cementing that.

The Taoiseach has not been straight with the House on this issue.  What has happened is unacceptable.  It is extraordinary that the Taoiseach could not answer the question I asked him.  Is it acceptable behaviour for the Minister to ride roughshod over established criteria which he had agreed with the Minister responsible for primary care, the HSE team and the Department of Health team?

Will the Taoiseach at least agree that the Minister, Deputy Reilly, should come before this House make a statement on the issue, outlining why he did what he did, and allow Deputies from across the House to ask him basic questions on this matter?  I understand a private notice question has not been accepted today.  This is a national issue concerning the roll-out of primary care centres across the country.

The Taoiseach: Of all the Ministers in this or any Government, Deputy Reilly has taken on the unenviable task of sorting out the wreckage left by his predecessors.

The criteria used, for the information of Deputy Martin, were the deprivation index for the catchment population of the centre and the service priority identified by each integrated service area and local health office.

Deputy Micheál Martin: The criteria for assessment?

The Taoiseach: An accommodation assessment, which reviewed accommodation available from the primary care team within catchment areas, was carried out by the HSE.

Deputy Micheál Martin: We know that.

The Taoiseach: It looked at the quality of the accommodation and whether it was spread over more than one building.  Additional criteria applied by the Minister, Deputy Reilly, were as follows: competition, GP co-operation, GP to population ratio----

Deputy Micheál Martin: Could the Taoiseach produce the documentation on that?

The Taoiseach: -----and cost-effective GP buy-in.

Deputy Micheál Martin: Could the Taoiseach produce the documentation?  This is all after the decision.

The Taoiseach: Deputy Martin will be aware of primary care centres which have been built but are empty because doctors would not move into them.

Deputy Micheál Martin: That has nothing to do with it.

The Taoiseach: Deputy Martin seems to have a propensity recently to keep talking.

Deputy Micheál Martin: I want answers from the Taoiseach.

The Taoiseach: If he wants to listen to the criteria, I will give them to him.

Deputy Micheál Martin: The Taoiseach is refusing to answer.

The Taoiseach: The remaining criteria were: existing health facilities; pressure on services, including acute services, to which I referred; funding options, including Exchequer funding through HSE build or lease; and, finally, the implementability of a PPP programme.  This was accepted, and by deciding to create a list of 35, as I stated, rather than 20, the Minister, Deputy Reilly provided positive encouragement for engagement and financial-----

and financial participation by GPs.  As I stated to Deputy Martin, there is little point in having taxpayers' money put together for primary care centres that remain unoccupied because doctors could not agree among themselves.  What the Minister, Deputy Reilly, put forward as his part of the stimulus package was a list of 35 based on these criteria from which 20 would be provided.

The Taoiseach: In fact, Deputy Reilly consulted with all of his colleagues in that regard.

Deputy Micheál Martin: He did not consult with the Minister of State, Deputy Shortall.

The Taoiseach: As I also pointed out, the HSE is engaging with the National Development Finance Agency, as required, to progress the primary care centre element of the Government's public private partnership.

Deputy Micheál Martin: Will the Minister make a statement to the House?

The Taoiseach: The Minister is due to answer questions on Thursday in the House.

Deputy Micheál Martin: Will the Minister make a statement specifically on this issue?

The Taoiseach: -----and any questions from members of Deputy Martin's party or any other Member in respect of this matter as is his responsibility under his remit.

Deputy Micheál Martin: He should come before the House today.

The Taoiseach: The Minister will be here on Thursday to answer questions on this.  Any other questions Deputy Martin can think of should be submitted before then.