Yesterday, nurses and midwives who are members of the Irish Nurses and Midwives Organisation, INMO, engaged in a 24-hour stoppage due to the complete failure of the Government and the Minister for Health to address the recruitment and retention crisis now gripping our health service. This afternoon will see hundreds of general practitioners, GPs, protesting outside the gates of Leinster House due to the lack of investment in primary care and the Government's failure to reverse past cuts to GP fees. The Psychiatric Nurses Association is today stepping up its industrial action through an overtime ban in advance of a three-day strike by those nurses next week. At the same time, we have the worst hospital waiting lists in Europe and last month, more than 10,000 patients spent time on trolleys in hospitals right across this State. To top it all off, we have the national children's hospital fiasco; a project that is now €450 million over budget.

This all adds up to a health system in a state of absolute and utter chaos. The situation in respect of the national children's hospital has descended into the realm of farce. This morning we learned from The Irish Times that senior officials from the HSE and the Department of Health who sat on the steering group for the hospital were flagging the soaring costs in respect of the children's hospital from October 2017 and almost every month after that. The Minister still maintains he was not informed or made aware of the costs overrun until August 2018. That time lapse does not sound credible but even if we do take the Minister, Deputy Harris, at face value, that does not explain why it took until November for the Minister to bring it to the attention of the Minister for Public Expenditure and Reform, Deputy Donohoe. Not once was the issue of an overrun mentioned and even in November, he did not personally tell the Minister of the €500 million overrun in that area. Can that be explained to us? The Minister, Deputy Harris, did not open his mouth about this project's cost overrun of €500 million for three months. It is utter madness, and shows the dysfunctionality in those Departments and at the heart of the Government.

The Taoiseach tweeted this morning: "We can get this project back on track." While we know that the Taoiseach is very much a man of spin rather than substance, what does that tweet mean? Is he suggesting that the figure he announced when he was Minister for Health, that of €637 million, would represent the project getting back on track? Alternatively, does he mean the figure of €982 million we were expected to believe would be the cost of this hospital or is it the €1.43 billion that is now suggested? Will that figure increase further? Is he suggesting that we are going to rein back costs on this project? The public does not have confidence in the Minister or the Government in this area and there must be accountability.

Any of the myriad of issues I raised at the beginning is bad enough in itself but combined, they are an illustration that there is something seriously and fundamentally wrong when it comes to health. The fact is there is incompetence and dysfunction at the top of the health service. It is crying out for direction and leadership and has been for many years. When will the penny drop with the Government that the Minister for Health is simply not up to the job?

It is true to say that we face many challenges in our health sector today but we have a fantastic health service. It is fantastic because of the people, doctors and nurses up and down the country who work on it.

They are all on strike.

The first issue the Deputy raised was that of the strike action happening at the moment. It is a very serious disruption for patients up and down the country. Tomorrow will see the second full-day strike of this week. Psychiatric nurses are also reducing their hours, and there is also an issue about GPs. We know that nurses are not taking this position lightly because we know how much they care about the patients they look after. In situations such as Storm Emma, we saw that they went above and beyond the call of duty to look after their patients. However, the Government does not take its position lightly either. We have to think about the potential outcomes that might arise if this cannot be resolved in an appropriate way. Contingencies have been put in place, which is important for people in the health system today. We have to think about how we can catch up on time that has been lost but we have done that before. We must bear in mind our responsibility to the public finances. We cannot jeopardise the current public service pay agreement. We cannot risk other strikes in other parts of the public sector and cannot endanger the important agreement we have at present, which is essential to the security of our public finances. It is true to say that it is important in the context of Brexit being on the near horizon; we are still working on contingency plans to deal with that issue. The belief of the Government is that we can find a resolution to this issue. It is very important that we do so quickly because of the escalation in action that is happening over the course of this week.

On the issue of the children's hospital, between the end of August or the beginning of September, when the Minister for Health, Deputy Harris, was made aware that there was the potential for significant overrun with the capital costs of this project and November, when the figures finally crystalised, he was getting to the facts of the matter. He was not working on innuendo or what he might believe but sought to understand the scale of the problem. When he understood the scale of the problem, the situation was relayed on the same day to Cabinet colleagues, including the Minister for Public Expenditure and Reform. Work then began on what decision had to be made, how it would be made, and what the consequences of the decision might be. Since that decision was taken by Cabinet in December, we have discussed this issue publically. There has been full transparency and accountability around that, but there is also a process in place, including the work of the Joint Committee on Health, where the Minister is answering questions by Deputy Pearse Doherty's colleagues on this topic in detail. The process also includes the PwC report, the terms of reference for which were published yesterday evening. The process seeks to get very detailed answers about what kind of oversight was happening, who knew what and when they knew it, whether proper procedures were observed-----

The Minister has just said the Government is on top of everything. Why do we need a report?

-----what we have learned from all of that and what we can do to try to save costs now, given what has happened in the past couple of months.

The Minister has mentioned the Government's responsibility to the public finances. Where was its responsibility or that of the Minister when it came to the overrun on the national children's hospital, running to €500 million of taxpayers' money? Where was the responsibility of the Minister for Public Expenditure and Reform when it came to one of those major capital projects that has now been beset by massive overruns? The Minister has spoken about the Government's responsibility when it comes to nurses but when it comes to a capital project such as this, it is clear that both Ministers were out of their depth, asleep at the wheel and kept in the dark by senior officials within their own Departments.

We learned in The Irish Times that the assistant Secretary General told the board in May that it had to go to the Government. It is incredible that the assistant secretary general would not have told his own Minister that there was a serious overrun. It is worse that the Minister, Deputy Harris, did not once, over August, September or October, a time when he was in direct negotiations with the Minister for Finance around a Supplementary Estimate for the Department of Health worth hundreds of millions of euro and a budget for 2019, tell the Minister for Finance that there was an overrun on this project. This Minister is out of his depth and not just on this issue. It is the fact that he has forced tens of thousands of nurses to take to the streets. It is the fact that people cannot go to their GPs today because they are on strike and are protesting outside these gates. It is the fact that people cannot get beds in our hospitals. It is the fact that we have hundreds of thousands of people-----

It is a fact that the Deputy is over time.

-----on hospital waiting lists. When will the penny drop? This is complete incompetence at ministerial level and departmental level. There is clearly serious dysfunction at the heart of Government and at the heart of these two Departments.

I thank the Deputy for his follow-up question. At the time in question, the GMP process was still under way, so the full facts of the matter were not established.

The responsibility of the Minister when he was informed that there was going to be the potential for this significant over-run - it was only in the August-September period last year - was to establish the full facts.

He never told the Minister for Public Expenditure and Reform. Is that it?

The idea was to have an interrogation of the process that was being finalised in the gross maximum price process. When he had the information, he brought it to the Minister and the relevant Department. The Taoiseach was then informed. A detailed memorandum was prepared for the Cabinet, on which we would then have had to make a serious decision. At the same time, the public was informed of that decision and we have since been having a public and transparent debate and bringing as much information to light as we can. Again, the Minister for Health was before the Joint Committee on Health this morning answering many of these questions, but we also have a PwC process and the terms of reference for that process.

I know that those in Sinn Féin struggle sometimes with the idea of due process and getting to the actual facts before they pull the trigger.

Fine Gael struggles with accountability.

As the Sinn Féin leader likes to say, the dogs in the street know. Ministers have been hung based on what the dogs in the street did or did not know before. We will follow due process, get the answers and act on the correct information.

What about the site? Can we get accountability on it?

Fine Gael has been in charge of the Department of Health since March 2011. We have come out of the austerity years and are now, I hope, in a position where we can bring the health system forward. Funding for the Department of Health and the HSE has grown from €14.2 billion in 2011 to €17 billion this year. As others have made clear, the Government has serious questions to answer about how there was an explosion in costs for the national children's hospital. It has serious questions to answer about how other hospital investments will be delayed or perhaps cancelled throughout the country as a result. It also has to fix the terrible problems stemming from the CervicalCheck scandal, not least the waiting times for checks to be processed that are inexcusably long.

I want to focus on the Government's record in managing negotiations. The Irish Nurses and Midwives Organisation is on strike. Those involved will be going on strike for a third day tomorrow. Where is the Government's ability to handle this situation? Why can it not sit down and engage in a serious process of negotiations well in advance of an actual strike? After nearly eight years in the Department of Health, I would have thought Fine Gael would have developed working relationships with all the major stakeholders, yet it seems years have slipped by and it has been unable to get to grips with these issues. We are now hearing concerns about the awareness of cost over-runs for the national children's hospital dating back to August 2017, one year before the Minister for Health was informed, apparently, and 15 months before the Minister for Public Expenditure and Reform was informed. It is his job, as set up by statute, to monitor public expenditure. The notion that the Minister for Health would know that he had to get all of the facts and that it took him three months to tell the Minister whose job it was to mind the money that there was a problem is startling.

The Government has been negotiating a new contract with general practitioners for at least four years with no outcome. In order for the programme for Government commitments to roll out more primary care centres to be achieved, we need to have the GP contract agreed to. In order for the Government's own commitments to provide free GP care for all children and young people under 18 years to be realised, we need to have the new GP contract agreed to. The latest report is that the Minister for Health began a new round of negotiations with the Irish Medical Organisation in October last year. I have two direct and simple questions for the Minister for Housing, Planning and Local Government. What progress has been achieved in the negotiations on the new GP contract? When, in his estimate, will the GP contract be signed off on and delivered in order that the programme for Government commitment signed off on by the Government will be brought to fruition?

It is important to acknowledge the increase in spending that has happened in the health service in recent years. The increase in spending has happened because we place such a priority on improving the health benefits and results for people going into the health system. Of course, we have challenges in the health system - every country does - because of the types of service we are trying to deliver. Over the course of that period we have increased the budget and seen more doctors, nurses, healthcare centres, as well as community supports and improvements in health outcomes, but challenges still remain.

Action is under way by the INMO. The mechanisms of the State are in place - the Workplace Relations Commission and the Labour Court. Both the Minister for Public Expenditure and Reform, Deputy Donohoe, and the Minister for Health, Deputy Harris, have said they are open to the engagements that could happen through that process as it comes to a resolution. However, this has to happen within the parameters of the public service pay agreement. This is because the agreement has been agreed to across the public sector and that is what we are working towards in getting public sector workers back to the position where they were before the crisis happened in their pay and benefits. That was an important negotiation and it has been agreed to. We want to and have to continue with it. We have a responsibility beyond the nurses. It applies to them, of course, but it goes beyond them to all public sector workers and the wider economy in terms of the public finances.

Deputy Howlin referred to the GP contract. An important engagement between the State and the IMO resumed in October, as the Deputy said, and there were intensive engagements at the time, especially in the weeks leading up to Christmas. Some progress was made, but there are outstanding issues. We need to ensure that, as we benefit patients, we also provide value for money for the taxpayer. The State's negotiating team is keen to bring a renewed focus to the engagement with the IMO in the coming weeks in an effort to bring matters to a conclusion. We believe we can bring matters to a conclusion because it is so important in terms of what we want to deliver through GPs. The ability to deliver the service through them and do so in a cost-effective way not only for the taxpayer but also in such a way as to avoid adding a financial burden to the individual, family or parent who wants to bring a child to the GP is crucial. We need to find money through savings in other parts of the healthcare sector because we are doing it with GPs.

These are only generalisations.

We recognise the important role GPs play in communities up and down the country. We are now involved in an engagement with them. People are engaging on behalf of the State to come to a conclusion as quickly as possible.

What is the point in vastly increasing the health budget if the Government is so spendthrift that it has no control over the escalating costs? A total of €500 million can go without being noticed. It seems that industrial relations and Fine Gael do not work well together. I again ask the Minister my questions, specifically about the GP contract. The doctors are outside. It is the next national crisis. There are vacancies in GP practices in every county. I can list the areas in my county of Wexford where we cannot get GPs to take up contracts. This is going to be crippling for the health service, unless we get a contract in place. Four years of negotiations should bear fruit, rather than the generalisms the Minister has provided for the House today. I will repeat my question. When does he expect a concrete result from the ongoing negotiations on a new GP contract? When will the Government be in a position to deliver on the programme for Government commitments to roll out GP services?

To categorise the additional money that will be spent on the children's hospital as just disappearing without notice is completely incorrect. It is money that is going into a state-of-the-art children's hospital that will stand for more than 100 years.

The Minister for Public Expenditure and Reform was asleep.

It will provide services, including emergency care and support services for families and children up and down the country.

The spend was not known by the Minister and neither was the over-run in 2017. It is incorrect to say it was. As we address these serious issues about which people are angry – we are angry too – it is vital that we get to the actual facts of the matter.

When was it known?

The issue being addressed in respect of 2017 relates to An Bord Pleanála and the additional sprinkler systems that had to be put in place. The cost was to be managed within the existing budget. That is separate from the information brought to the attention of the Minister for Health, Deputy Harris, at the end of August or the beginning of September on the potential for a significant over-run. It was only crystallised at the beginning of November, at which time the other Ministers were then informed of the seriousness of the issue and the Cabinet took its decision in December.

What is the Minister's definition of "significant"? Is it €5 or €5 million?

It was crystallised.

Deputy Howlin asked about the GP contract. Of course, we have to get the facts of the matter. The Deputy should know as a former Minister for Public Expenditure and Reform that we cannot make up figures or pull them out of the air. We have to drill down and get to the actual numbers and then bring them to the Minister and the Cabinet. We need to get to the facts. As I said in my previous answer, intensive engagement began in October and continued right up until the weeks before Christmas. There are a number of outstanding issues. The engagement will resume shortly and we hope conclude shortly thereafter because of the important role GPs are playing in terms of the future delivery of health services.