Primary care centre selection
Opposition deputies challenge the transparency and consultation behind the selection of 20 initial and 15 additional primary care centres, alleging political manipulation and questioning confidence in the Health Minister. Minister Burton defends the process, saying the line Minister made the detailed decisions within available funding, while Cabinet approved the overall policy and the centres will expand local healthcare.
Please do. I am delighted to have the opportunity to extend and elaborate on some of the points I made in my opening remarks.
The bottom line is that the selection process for identifying primary care centres on the Government's list was ripped apart by the Minister for Health, Deputy Reilly, as seen in the letter released yesterday under the freedom of information process. He stated he consulted with a whole range of people - except, apparently, the Minister of State in his own Department. He said he consulted, for example, with his Cabinet colleagues. The Taoiseach put it on the record of the Dáil some days ago that the Minister consulted with all his colleagues in that regard. I put a direct question to the Minister for Social Protection, Deputy Burton, some moments ago. Was she consulted on the inclusion of the additional 15 primary care centres as announced by the Minister? Apparently, the Minister for Transport, Tourism and Sport, Deputy Varadkar, was not consulted, because he made his views known on a television programme, commenting that it looked like stroke politics.
The game is well and truly up for the Minister, Deputy Reilly. He brought about the resignation of the chief executive officer of the HSE, lost the CEO of the VHI and has now effectively forced out a Minister of State in his own Department who took a principled stance and was determined that the objectives on health care in the programme for Government would be implemented swiftly, in a fair manner, and in a manner that ensured that scarce resources would be allocated to those most in need. Instead, the Minister, apparently with the full support of all his Cabinet colleagues, rode roughshod over the process whose integrity the former Minister of State, Deputy Shortall, was trying to ensure. Will the Minister, Deputy Burton, state whether she had knowledge of the additional 15 centres being added to the list? Was she included in the process, and is she satisfied about the criteria used by the Minister for Health?
The bottom line is that the former Minister of State, Deputy Shortall, took a principled stand yesterday, but the wrong Minister has resigned. The game is up for the Minister for Health, Deputy Reilly, and the clock is ticking. Will the Minister for Social Protection now put on the record whether she has total confidence in Deputy James Reilly as Minister for Health?
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First, in regard to my colleague, Deputy Shortall, I am very sorry and saddened to see her go. That view is obviously shared very strongly in this House by colleagues in both parties.
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Members of the House who are fair will recognise that she is a talented and compassionate woman, a person of very firm resolve, and very ambitious and driven in regard to the political values in which she believes. As colleagues, both of us were elected to the Dáil in 1992, in the aftermath of President Mary Robinson's historic election.
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She has been my colleague for a very long period.
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Will she be your designated leader?
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I value her. We were discussing the medical centres and I will return to that. However, in speaking about the scourge of alcohol misuse and drug abuse in this country, Deputy Shortall spoke truth to power. That is the job of every politician, whether in opposition where one has much more leeway, or in government. She did that.
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She did not get support from the party.
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With regard to the Labour Party, I do not know about the relevance of James Connolly-----
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-----to the speakers; I suspect they owe more to people such as Leon Trotsky than they owe to Connolly.
At the time of the last election, the Labour Party went to the people and asked for a mandate - as did the members of the Fine Gael Party - to put this country straight, recover its economic independence and sovereignty and make changes.
That is what the Labour Party signed up to do and what it intends to do. That is what the Labour Party has promised to do for the people of Ireland, as has Fine Gael in terms of Government. Does everybody in Fianna Fáil get on with everybody else every day?
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Does everybody in Sinn Féin get up in the morning and smile-----
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Does the Minister get on with the Tánaiste?
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Politics is about the art of argument, principle, having policies and resolving-----
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Does the Minister talk to the Minister, Deputy James Reilly?
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-----and bringing people together.
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Will the Minister answer some of the questions?
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The clock is ticking, Minister, and you have not answered any questions.
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The Government is here to do a job on behalf of the people. The people elected the Government to do that.
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The Minister has not answered the questions.
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As a consequence of the joint work of Deputy Reilly, as the Minister for Health-----
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Does the Minister have confidence in him?
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-----and Deputy Shortall as Minister of State for GP care, we have a considerable set of achievements. We have the legislation on the A list of the Government's agenda in regard to primary care that will be taken shortly.
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That is really helpful to patients.
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I will conclude on this point. We have now a pipeline of projects in regard to health care centres-----
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A pipeline of hot air is all you have.
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-----which will transform the face of primary care here.
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What about the questions, Minister? You are talking down the clock.
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We must remember that at the end of the day, and I believe Fianna Fáil shares this view, we will make better use of our health services-----
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-----if we have more people treated at the primary level. The former Minister of State, Deputy Shortall, and the Minister, Deputy Reilly, share that view, as does the rest of this Government.
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Unfortunately, the Minister chose not to answer any of the questions I put, and they were very straightforward questions-----
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-----which required a "Yes" or "No" answer. I will come back to those but this issue is not about people getting on with each other or not getting on with each other. This issue is about the substance of policy, the direction of policy and the manner in which that policy is being implemented. Deputy Shortall had a fundamental disagreement with the Minister, Deputy Reilly, and his Cabinet colleagues on those issues. I ask the Minister again. Is she satisfied with the lack of transparency surrounding the choice of the additional 15 centres? More importantly, and it will be more than pointed if she does not answer this question directly, does she, as Minister, have unequivocal, total confidence in Deputy James Reilly as Minister for Health? She cannot evade that question. Already, she has denied him at least three times. Can she please tell us, "Yes" or "No", if she has confidence in the Minister?
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Let me make it clear, as I have done on many occasions, that everybody in the Government has confidence in every other Minister.
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I have confidence in the Minister, Deputy Reilly. I have confidence in every member of the Government. I have a mandate from the people as a consequence of the last general election to implement the programme for Government.
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In terms of the programme for Government, Members should bear in mind that we inherited a difficult situation in health which even the Deputies opposite acknowledge. We are dealing with that and at the end of this process we will have a set of 20 primary care centres throughout this country which will inform the experience of patients-----
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Was the Minister consulted on the extra 15?
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-----in terms of how to access modern medicine and modern facilities in their own location.
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Was she consulted, "Yes" or "No"?
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That is an enormous achievement, and we will do that for the people. We have a vision in regard to health and universal health insurance that will put us on a par with other European countries where we will develop a unified health service that will provide for all our people, regardless of their income.
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Did the Minister know about the extra 15?
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That is the objective of this Government.
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I call Deputy McDonald. I ask Members, in the interest of democracy, please to allow the person put the question without interruption and allow the Minister to reply without interruption. Thank you.
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This has been an interesting session so far.
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When all of the controversies emerged around the Minister, Deputy Reilly, it was sort of episodic. There was the issue to do with his personal finances, the issue to do with his interest in private medicine, particularly in a private nursing home, the debacle around the €130 million of cuts and so on and it became apparent to me at least that Cabinet would circle the wagons, the backbenchers, probably happily enough in Fine Gael and, with a sense of unease, the Labour Party would join suit, and that the lads would stand by their man.
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From what the Minister is saying, she is with them on that. She is standing by her man, Deputy James Reilly, despite the fact that anybody with an ounce of wit could see that the man is not a suitable occupant of that Ministry. That is my first point.
The second point is that the Minister gave an ode to Róisín. She said she is talented, compassionate and ambitious. I have no doubt she is. I suggest that those are all the qualities required for a Minister of State with a brief as critical as the Minister said primary health care is yet Róisín has walked. She is gone, and she has told us the reason. She told us it was because she does not believe there is sufficient commitment to the delivery of the programme for Government in the area of health. We are not speculating about that. That is what she has told us.
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She has further told us that there was not transparency in the decisions around the primary health care centres. We are not speculating; the woman has told us that.
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I put the question to the Minister, and it has been raised with her already. Was she part of the consultation with her man, the Minister, Deputy James Reilly, in respect of diddling the lists-----
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-----of primary health care centres? Was she part of that discussion? Did she sign up to the additional criteria? Is she satisfied, unlike her colleague, Deputy Shortall, that there was no stroke politics involved and that the criteria were set out and agreed upon? Did she sign off on the addition of these extra primary health care centres?
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I appreciate Deputy McDonald's interest in country and western but I am no Tammy Wynette and I do not think she is either in relation to-----
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Deputy McDonald is challenged occasionally with her own Tammy moments in regard to her own leader and therefore she should deal with that as well.
On the questions about what happened in the Department of Health, and I appreciate Deputy Michael McGrath and Deputy Mary Lou McDonald have not served in Government, the actual detail working out of proposals is a matter for the line Minister. It is extremely unlikely that other Ministers would be involved in the detail other than-----
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But he said you were consulted.
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Excuse me. I did not say anything.
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The Departments normally involved would be the Department of Finance and the Department of Public Expenditure and Reform because it is a matter of public expenditure. Other line Ministers would not be involved in any of the detail on this issue. That is the honest answer.
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It may have been different in Fianna Fáil. Perhaps everybody came into the room and looked at the list. That did not happen in this case because it is for the line Minister to deal with it, and that is what would have happened. The Deputy is trying to create something that in terms of Cabinet and the way Departments operate does not happen.
The point is that there is a preliminary list of 20 locations and a second list of a further 15 locations-----
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-----which will give us flexibility and options in order to ensure that when we go to GPs and primary health care providers, we will achieve the objective of having a series of centres built on time designed to facilitate the provision of modern primary care services. There may be different views on how that was done and such views are legitimate. However, the way Cabinet government works is that, provided the funding is available via the Departments of Finance and Public Expenditure and Reform, the line Minister makes these decisions. As someone who previously had the honour to serve as a Minister of State in three Departments, I am fully aware of the fact that the line Minister who is, after all, a member of the Cabinet-----
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------retains seniority and has responsibility for making final decisions.
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The Minister, Deputy James Reilly, referred to intensive and inclusive discussions.
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Having said that, I have no intention of disparaging someone who served as a Minister of State. I merely wish to set the record straight with regard to how Cabinet government and individual Departments operate. The critical point is that we must allay the fears of the people who, at a time of very deep economic crisis, are anxious to see investment in primary health care. Everyone is aware that the way to deliver better medical care to people and ensure they have all the necessary tests is to establish modern primary health care centres close to where they live. In the context of that matter, the Minister for Health, Deputy James Reilly, the former Minister of State, Deputy Róisín Shortall, and the rest of the Government are at one.
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I suppose that, in spite of herself, the Minister has added clarity to the debate in as much as she has set the record straight.
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The Minister has informed us that Cabinet colleagues were not consulted in the manner in which the Taoiseach led us to believe they were. The Minister has also indicated that her colleague, the Minister for Public Expenditure and Reform, Deputy Brendan Howlin, was perhaps aware of the details of this matter but that she was not.
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The Minister, Deputy Brendan Howlin, was not aware of it.
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I hope the Ceann Comhairle will bear with me, particularly as I did not avail of the opportunity to make a statement earlier.
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The reason this matter is so important is that Deputy Róisín Shortall - I presume the Minister for Social Protection will concede the latter knows about Cabinet and high government - has informed us that, to use common parlance, there was "funny business" going on with the list. The Taoiseach absolutely refuted her claim and stated the criteria used had been clear and that Cabinet colleagues had been consulted.
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The Minister for Social Protection has now completely unpicked that version of events. To her credit, she is being honest in that regard. This proves that the stroke or parish pump politics we thought had been consigned to history with the previous Administration are alive and well on the watch of Fine Gael and the Labour Party. What is tragic about this is that it says to people that not only can they not trust Labour Party in government but that said party cannot trust itself in government.
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The Minister for Social Protection has indicated that she has full confidence in the Minister for Health. Deputy Róisín Shortall indicated the same thing last week when she voted confidence in him. However, it appears that the criteria were not clear, that the Labour Party Ministers were not consulted and that the Minister for Health, Deputy James Reilly, went on a solo run. However, those Ministers are now circling the wagons and standing by their man-----
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-----irrespective of their party's stated position of transparency and standards in government, which is absolutely shocking.
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I reiterate that the Deputy is choosing to misunderstand, which is her privilege.
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I fully understand the position.
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What the Minister for Health, Deputy James Reilly, said last week actually reflected the process which had been undergone. The then Minister of State was required to draw up the first list of 20 locations. The criteria in this regard were very specific and related to disadvantage and need. The senior Minister added a series of additional locations-----
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-----in order to reflect further considerations. He is on record as stating this. As is the case in respect of all decisions required on issues of this nature, the Minister then brought the matter to the Cabinet. Deputy Mary Lou McDonald is suggesting everyone in the Cabinet sat down and went through the list. That is not the way it works.
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The choice of locations would have been subject to finance being available, which is a major issue. The Minister for Health made the final decision on the matter which was then agreed by the entire Cabinet. However, the entire Cabinet would not, as Deputy Mary Lou McDonald is trying to suggest, be involved in discussing the minutiae and detail of this matter.
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I did not say the Cabinet was involved, the Taoiseach said it.
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The decision on this matter was based on the very important proposals brought forward by Deputy Róisín Shortall, after very careful work on her part in selecting locations on the basis of deprivation and need.
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The Minister for Health must be getting very nervous about all of this.
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Deputy James Reilly, as the senior Minister, amended and expanded the list in order to provide for sustainability and viability vis-à-vis the proposals in order that all of the relevant health centres would be built within budget and on time, in line with the programme for Government-----
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-----and in accordance with the funding available. The key point is that within a relatively short period there is going to be a really important and fundamental addition to primary care services. The success that is going to be achieved in this regard will be a credit to Deputy Róisín Shortall, the Minister for Health, Deputy James Reilly, and the Minister of State at the Department of Health, Deputy Kathleen Lynch, all of the members of the ministerial team who were in place when the decision was made.
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Therefore, its a great result all round this week.