Leaders' Questions

Deputy Micheál Martin

Last week I asked the Taoiseach some basic questions about the HSE's or the health service budget, but he did not answer the questions I asked. He went on a general tour of spending generally and within the context of health services. My fundamental point last week and this week is that we are essentially being misled by the Government and the HSE on the budget for the health service in 2018. The service plan was published, but the very fact that it was published in December after the budget was a problem in terms of transparency and honesty about the figures. I asked a very basic question as to why it had taken a freedom of information request to reveal that the bulk of approximately €346 million in savings identified in the service plan would not be realisable and that the CEO of the HSE was saying this was extremely challenging. That is not to mention the deficit of €172 million. There is no real understanding of how it will be provided for. I refer to what the HSE is stating about existing levels of service and the funding required.

The budget represents an increase of €413 million on the final figure, the outturn, for 2017, which is the crucial figure. It represents an increase of approximately 2.9%. Pay accounts for approximately €278 million of this sum and is part of public service pay agreements. Demographic costs constitute the big issue facing us all in terms of spending. In the light of these costs, the amount allocated is hardly adequate, but it is a significant factor. Basic health inflation, the incremental cost of developments in 2017 and so on must also be borne in mind. There is a figure of approximately €196 million for new service developments. One then has to factor in savings of €346 million. When one goes through the figures - it can be confusing to the public at large - one notes that, in essence, the HSE will find it extremely difficult to deliver services at the level they were provided last year, never mind expand services. That explains why those working in the health service cannot work out all of the general talk about global figures and increases when hospitals such as St. Finbarr's are being asked to accept a cut of up to 21 whole-time equivalent positions when ten beds lie unoccupied in Bandon, despite the fact that there are now considerable issues about elderly people finding placements in long-term care settings and when revenue funding was refused in Letterkenny, despite record levels of overcrowding. It explains the disconnect. There is a massive fudge in the presentation of the health figures.

Will the Taoiseach release all of the correspondence between the HSE and Minister leading up to the Estimates and the budgetary process? It is absolutely unacceptable that we must rely on freedom of information requests to find out the real story about the concerns of the chief executive officer of the HSE about this year's Estimate. Will the Taoiseach facilitate meetings between HSE directors and leaders and spokespersons of the various political parties in order that there can be a fully transparent assessment of the implications in 2018 and for the health budget in general? Does he accept that there is a fundamental credibility problem with the figures, as presented, for the health service Estimate for 2018?

The Taoiseach

The HSE service plan is credible, provided it is adhered to. It is always a struggle for the Health Service Executive, most public bodies and Government agencies to remain within budget every year. The funding they would like to have to do what they want to do will always be lower than what can be provided by the Government through the taxpayer.

As is always the case every year, the HSE will have to work very hard to stay within budget but the HSE service plan, which the Government approved and which was signed off on before we approved it, is credible if what is in it is adhered to. What is in it is that we will have - at the very least – the existing level of services we had last year plus a number of specific improvements that are funded. The funding is being held in the Department of Health to make sure those improvements actually happen and will be given to the HSE as they happen. That is what we expect to be done, but it will be a struggle. There will be plenty of engagement and over and back involving the HSE, the Department of Health and the Department of Public Expenditure and Reform and as the year goes on, as we sort this out, but the overriding objective is one that results in, at the very least, the existing level of service and on top of that the additional €200 million or so that is being provided for new services being spent on those new services and not being sucked into other costs.

As Deputy Martin said, it is an increase of €413 million on the outturn last year. That is a real increase and that is on top of a very high base. Let us not forget that our health budget is now the highest ever since the foundation of the State. On a per capita basis, we now spend more on health than almost any other country. We are in the top five. Even during the recession our health spending was above average per capita. The fundamental problem in the health service - there are problems - is not solely one of resources. It is about how resources are deployed, and they are not deployed as they should be. When one looks at something that has got a budget of €15 billion and we are talking about €450 million, €500 million or €800 million, we are talking about a variance of 6% or 7%. We are talking about the effect of 6% or 7% of the health budget. Why not look at how the 100% is spent? Let us imagine if the €15 billion was spent well and efficiently what kind of health service we could have. Instead, we only ever talk about the increment - the 1%, 2%, 4% or 5%. That is what is wrong. Fundamentally, what we have is a health service where all problems get monetised and then they get passed on. That is not working. It will not work as a system and it must change.

To answer Deputy Micheál Martin's specific questions, the service plan for the health service must be done after the budget. It cannot be done until the HSE knows what its budget is and that is in the health Act. I think Deputy Martin might have been the person who brought the health Act through the Oireachtas so that is where it comes from but it might have been the Minister who took over from him, Mary Harney.

In terms of the correspondence, the Minister for Health has advised me that it has all been released under freedom of information already. The HSE goes before the Oireachtas committee on a quarterly basis to account fully for its actions. Any Oireachtas Member, including those who are not members of the committee, is free to attend such meetings.

Deputy Micheál Martin

The starting point is honesty and full transparency in terms of the health budget and we did not get that this year either in the preparation and lead in to the budget or in the service plan. We only got elements of it following the release of freedom of information requests to a journalist in The Irish Times. If the Taoiseach reads The Sunday Business Post there was a very good article again last week highlighting a fundamental problem - a lack of honesty and a massive fudge going on in terms of the presentation of the budget.

It is interesting to note, for example, a project for renal services in Tallaght hospital. The tender was originally issued in December with the intention of awarding a contract in March. Now the HSE has extended the tender process until October. Why? It is so that the spending will not happen until perhaps January or February of the following year. That type of behaviour is becoming endemic because of the lack of honesty around the budget. The Taoiseach mentioned €200 million. A total of €48 million of that is for pensions - demand-led schemes. There is also increased funding for drugs.

The Taoiseach knows all of that so there is no point in trying to pretend. One of the more important admissions today is that the Taoiseach is now admitting that at the very least we will get existing levels of service. If that is all we are going to get in 2018 it will be a very rough ride for everybody working in the health service and more particularly those who avail of the health services, especially elderly people and those with dementia, where there is clearly not enough provision to cover the challenges that will undoubtedly come our way in 2018.

The Taoiseach

The sum of just under €200 million is for new service developments. It is not for pensions. That is separate funding. We are ring-fencing the money specially and holding it back in the Department of Health to make sure the money is spent on what it is intended for and not lost in some deficit elsewhere. I refer to things like, for example, the extra €10 million for respite funding, the additional 190 beds in acute hospitals that have already been opened this winter and also the additional €750 million for home care.

Of course we should set aside funding for new drugs and that is a service improvement.

There is one thing on which I will agree with Deputy Martin. I would like to see more transparency around the health budget. Deputy Martin mentioned in his question that the increase in our health funding is going to be €413 million ahead of the outturn last year. Even now, that is only a projection. We actually do not know how much the health service spent last year. We will not know until April how much the HSE spent last year. Even when a person is looking for transparency and that person is sitting where I or the Minister for Health, Deputy Harris, is sitting, the financial systems are so outdated and badly organised in our health service that it is April before the person knows how much was spent last year. We are going to need a major investment, first in information technology to have a proper financial system, and second in capacity to have people who are able to manage and follow budgets. That is something that is going to change.

An Ceann Comhairle

Time is up.

The Taoiseach

If Deputy Martin submitted a freedom of information request on the correspondence between Ministers and Departments for every public body in the State, I guarantee him that every Department and agency asked for more money than they got. That is how the budgetary process works.

Deputy Micheál Martin

That is not the point about freedom of information requests. The Taoiseach is saying the €347 million figure is not credible. He knows this.

The Taoiseach

If we take all Departments and Government agencies together, they sought additional increases in spending of €12 billion last year.

Deputy Louise O'Reilly

When the Taoiseach spoke at last night's press conference, he showed leadership and spoke for all of us who want to see the eighth amendment repealed. I thank the Taoiseach most sincerely for that.

Today is a momentous day for Irish women and society. The insertion of the eighth amendment into the Constitution was a grave wrong perpetrated on women. My colleague, Deputy McDonald, said it best when she said the eighth amendment was in effect a constitutional coup and the reactionary codification of the suppression of women.

There are those who have never stopped campaigning against the eighth amendment. They have been campaigning since 1983. Some, like my parents and people in this Chamber, were campaigning beforehand to ensure it did not get in there in the first place. They have been joined by many young people and the protests have not gone away. Indeed, the Taoiseach will be aware that the protests have intensified, from the blog posts and articles to the lobby emails, meetings at constituency clinics, tweets, online campaigns, the difficult conversations and the easy ones, right up to the marches and protests. We would never have arrived at this point without their courage and activism. In many ways, today is their day.

I must also offer thanks again to the work of the Citizens' Assembly and my Oireachtas colleagues on the Joint Committee on the Eighth Amendment of the Constitution. The findings, as expressed by them, left no option but to proceed to call a referendum on the issue. It now falls to those of us who want to see that change and see the eighth amendment banished as a relic of the past to join together, stay strong and campaign as one to see the eighth amendment gone.

I welcome the confirmation that the Taoiseach and the Minister for Health will campaign for repeal. Likewise, Sinn Féin and I will be on that campaign trail. It behoves those of us politicians who believe in repeal to campaign for the change we really want to see. That is what politics is about. It is about real political leadership. We repealers must be prepared to debate, campaign, canvass and be respectful, even when that respect is not always evident. We must use the facts and speak to the people, who I firmly believe are ready for this change. Those of us who support repeal must come together and be unified in our campaign. Perhaps to demonstrate that, I am offering to pop over to Dublin West, where the Taoiseach and I, along with Deputy Coppinger, Deputy Burton and councillors from all parties, can come together and knock on a few doors. Perhaps the Taoiseach might join me in Fingal to do the same.

I would like to ask the Taoiseach to commit to publishing in full the advice of the Attorney General. The decision to repeal and have an enabling clause in the Constitution for the Oireachtas to legislate was not endorsed by the Joint Committee on the Eighth Amendment of the Constitution. I believe it is necessary for all politicians and the public to be fully informed on this matter. Will the Taoiseach state his commitment to holding that referendum before the end of May to facilitate students and young people being allowed to vote?

The Taoiseach

I thank Deputy O'Reilly for her opening remarks, which were very generous. I echo the sentiments she expressed concerning the important work of the Citizens' Assembly of just under 100 randomly selected citizens who studied this topic weekend in and weekend out and came to the conclusions they did, as well as the work of the all-party committee and all its members who studied the recommendations of the Citizens' Assembly and made further recommendations to Government. I agree with the Deputy that for those who agitated for reform going back over the past 20 or 30 years, if not before that, this is their day.

This is now a matter for the Irish people. It is in their hands and it is right that they should be asked this question. When it was last asked, I was under four years old. Nobody aged under 52 years has had a vote on the issue of Article 40.3.3° of the Constitution and it is appropriate that people be allowed to have this vote. I appeal to Members, even those who do not agree with repealing the eighth amendment, to vote for the referendum Bill and at least allow other citizens to make a decision for themselves.

I will say only two things about the campaign and debate we will have in the next few months. It should be respectful of all sides and it should never be personalised. I agree with the Deputy that even when people are not respectful towards us or personalise the debate, we should not respond.

To answer the Deputy's question, the Minister for Health will today publish what is called a précis paper. This is a summary of the Attorney General's legal advice and an explanation of the rationale behind his advice. This is somewhat unprecedented, although something similar was done in 1983. As the Deputy is aware, legal advice is privileged for very good reasons. However, we are happy to make an exception on this occasion and publish the précis paper. The Minister for Health will also hold a briefing for Opposition leaders and spokespersons at 4 p.m.

I affirm my commitment to holding the referendum before the end of May to maximise participation. I must add a caveat, however, by stating the obvious fact that I do not command a majority in this House and we no longer use the guillotine except by agreement of the Business Committee. With the co-operation of the House, we can certainly have this done by the end of May. We are already making preliminary moves to establish a referendum commission in order that it is in place on time.

Deputy Louise O'Reilly

I assure the Taoiseach that Sinn Féin will co-operate fully with the Department of Health to ensure the legislation is processed as soon as possible. I reiterate my call to publish the full advice of the Attorney General. I do so because this is one of the recommendations that the Joint Committee on the Eighth Amendment of the Constitution did not endorse. The committee received its own legal advice, which seems to be at odds with the advice available to the Government. All the information should be placed in the public domain. Deputies have called for a fact-based campaign and we have all stated we will rely on the facts. It is essential for transparency that Deputies have the advice of the Attorney General in full. It will enable us, when knocking on doors either separately, together or however it happens, to have the full facts and to explain to people who know they are about to make a momentous decision and want to be informed of all the facts.

The Taoiseach

As the Deputy knows, legal advice and the advice of the Attorney General to the Government are privileged and it is not the norm - it is in fact somewhat unprecedented - to produce legal advice. Legal advice inevitably argues from a position of "on the one hand, on the other hand" and gives different sets of opinions. The advice we will publish today is a summary of the advice of the Attorney General. It sets out his conclusions in a detailed paper that explains exactly why we are proposing that an enabling provision be added to the Constitution. To put the matter simply, if we only repeal the eighth amendment or Article 40.3.3°, we go back to where we were in 1982 when it was argued that there were unenumerated rights of the unborn and there may have been a pre-existing right to life of the unborn. There is also a possibility that courts could find in future that the foetus or unborn child is a child, in which case children's rights would apply, or is a citizen or has a right to be a citizen, in which case citizens' rights would apply.

We do not want to be in a situation where the majority of the people vote to repeal the eighth amendment only to find out that it has no effect, and that there is still a ban on abortion in our Constitution. That is why it is proposed to insert a very simple enabling provision clarifying that the Oireachtas may legislate for the regulation of the termination of pregnancies. That, however, does not mean that there is any barrier on recourse to the courts or judicial review.

Deputy Mick Wallace

I am sure the Taoiseach is familiar with Accenture, the IT management company. It has positioned itself as one of the top earners of external contracts from Government Departments and State agencies. Various Departments are availing of its services, but its No. 1 contract in 2016 was with An Garda Síochána, which paid Accenture €26.5 million, and as astonishingly high as that figure is, it gets worse.

An audit by the Garda internal audit section into Garda information and communications technology, ICT, payments for 2016 and completed in August 2017, which RTÉ's John Burke got following a freedom of information request, found serious problems with the Garda contract with Accenture. The aim of the audit was to examine the payments process in ICT, specifically the authorisation of payments and the contractual position with vendors, and to obtain assurances that projects were monitored. The audit also sought to obtain assurances that control over expenditure on ICT was sufficiently robust to satisfy the European Commission. The audit found no assurances that public procurement requirements were being complied with, and this represented a high risk. The Garda contract with Accenture, which was provided to the audit, is dated August 2009. The audit stated that, as this contract was not renewed since 2009, it was not satisfied that An Garda Síochána complied with procurement obligations. The audit notes that Accenture staff are the only external IT contractors who do not record their attendance and hours on an electronic clocking system. The audit also found that controls over payments were generally effective, but not in the case of Accenture. Not only are there problems with the contract and the staff, the audit also found that An Garda Síochána had been paying Accenture in advance, before the work was done, and that this was highly unusual in An Garda Síochána and, as the Taoiseach will know, it is pretty unusual in most businesses.

Neither did any of the new arrangements which had been made with Accenture since 2009 go out to tender. Accenture is the very same firm which developed the now infamous PULSE system, which the head of the Garda Inspectorate, Robert Olsen, said was not fit for purpose, was 1990s technology and was time to be retired. That was more than two years ago.

Who in An Garda Síochána has the authority to make these payment decisions? Does pre-paying a multinational company millions of euro on a contract nine years out of date with staff who do not even clock in properly sound like value for money? Someone needs to be held to account for this. How much does the Department of Justice and Equality know about what is going on? I put in a parliamentary question on 1 June 2017 about all Garda contracts with Accenture. I got the information in a reply on 19 December, more than six months later. Is the Department in the dark about what is going on? Is this the norm for Accenture? It has contracts with numerous Departments and agencies. Is this happening in other areas as well?

The Taoiseach

I am familiar with Accenture. I think it is a very good firm. It does a lot of important work in the private sector and has a lot of Government contracts as well. I think it had a contract in my former Department, the then Department of Social Protection, which I assume was tendered in the normal way. Public bodies should always follow public procurement rules, full stop. If it is the case that An Garda Síochána did not follow proper public procurement procedures, that is not acceptable to the Government. The reason we have public procurement rules is to ensure that companies can bid and get a fair crack of the whip when it comes to applying for public contracts. It is also how we ensure that taxpayers get the best value for money and how we ensure citizens get the best outcomes. I discussed the matter with the Minister for Justice and Equality, Deputy Charles Flanagan, and we have sought a report from the Garda Commissioner into this issue.

Deputy Mick Wallace

There is no "if" about whether the Garda followed proper procedure. The Garda internal audit has established that it did not. This is not something that happened overnight. The 2015 accounts for An Garda Síochána state 73 contracts breached public procurement guidelines. This issue was raised at the Committee of Public Accounts by Deputy Catherine Connolly in July 2017 and the director of finance for the Garda, Mr. Michael Culhane, replied: "I accept that the 73 number is high, but we are actively addressing all of those issues and working with the Office of Government Procurement." Let us fast forward to the 2016 Garda accounts which were released in September 2017, according to which 94 contracts breached public procurement guidelines. Things had got worse, not better. What is going on? What is the Office of Government Procurement doing when the director of finance for the Garda says the force is working with that office? What does that mean? These are questions that need to be answered. How can one company be treated so differently? Who has benefited and who was pulling the strings? Does the Government have the appetite to hold the decision makers to account?

Raising issues about the dysfunctional nature of An Garda Síochána has become a little like shooting fish in a barrel. There was a time when it was sacrosanct here not to challenge it and we were ridiculed for doing so. Now it has become a popular sport. Will the Taoiseach tell us when will all of this change? There are so many aspects of An Garda Síochána that remain dysfunctional. Will he change things? How and when will the Government do so?

The Taoiseach

I acknowledge that there have been irregularities in Garda finances. We saw it very evidently in the financial affairs of the training college in Templemore and we have seen it on a number of occasions in the non-collection of fees and fines. We see it in irregularities in how contracts are tendered for and awarded. We are in the process of implementing a significant programme of Garda reform. It involves, for example, the establishment of the Policing Authority, which holds the Garda to account in public. It also involves greater civilianisation of the organisation by bringing people into it who are experts in human resources, finance and all corporate governance functions. It involves the Commission on the Future of Policing, which is now doing its work.

Deputy Mick Wallace

The Taoiseach is avoiding the questions asked.

The Taoiseach

We await its report. We will have the recruitment of a new Garda Commissioner and I intend that he or she should be able to come into and be a broom in the force and also bring people with him or her to change the organisation from the top. That is the only way it can be changed.

Deputy Michael Harty

I wish to question the Taoiseach on the issue of the dysfunctional health service, particularly where it fails to deliver timely care to patients. I will approach it differently from Deputy Micheál Martin who addressed budgets. I would like to question the Taoiseach about reforming the health service and would like him to look at doing so through a different lens. I ask him to look at it laterally rather than just in the context of budgetary measures. He should not look at hospital care as being the default method of supplying care to the population; rather community care services should be the default provider to keep people out of hospital and keep hospitals for those who need complex or emergency care. This does not in any way negate the need for increased hospital capacity, diagnostics or staffing.

The second way the Taoiseach should look at the health service is to look at anticipatory planning and reform rather than reactive planning and reform, which is what we have. The ten-year Sláintecare plan has been lying idle for the past eight months.

Third, integrated structural and cultural reform rather than emergency planning is needed in the health service. That will be key to demanding accountability and responsibility in the health service. It costs a lot of unnecessary money to run a disconnected and fragmented service and expanding an inefficient service will not make it more efficient. How we spend our money is more important than how much we spend.

Where are the political will and determination to reform the health service? We know that reform will be extremely difficult, but that does not mean that it should be seen as impossible. Proper structural reform should not frighten the Department of Health, the HSE, staff or patients, as proper reform of the health service would benefit everybody. It is an abuse of staff to expect them to work in unsafe conditions as they do. The circumstances to which patients are subjected in hospitals when trying to access timely care infringe on their human rights. It also leads to the recruitment difficulties which present a serious problem in the health service. Rationing health services because the Government is not willing to reform the health service is no longer acceptable. The trolley crisis is but the tip of the iceberg of the dysfunctionality. It grabs the headlines, but it tends to distract from and hide the fundamental structural deficiencies of the health service. Even if we were to eliminate the trolley crisis, we would still have not resolved the dysfunctionality issue. Is the Taoiseach satisfied to lead a Government which allows an inefficient Department of Health and HSE to continue working in the manner in which they have been? Will he outline the actions he will take to reform the health service?

The Taoiseach

When we talk about the health service, it is important to acknowledge the many difficulties we face, particularly in access. They include people waiting for outpatient appointments or surgery or waiting to be given a proper hospital bed. We have real problems in access to the health service, but we should not ignore the many good things which happen in it every day. Life expectancy in Ireland is among the highest in the western world and improving because of good personal health and the health service. When Irish people are asked to rate their own health, they rate it higher than people from any other country. More than 80% of patients who are asked about their experience of the health service say they have had a good experience. One would not think it, but when people are actually asked what they think about the health service, more than 80% say they have had a good experience. Notwithstanding the real problems in emergency departments, two thirds of patients are either seen and sent home or in a hospital bed within nine hours. As a country, our patient outcomes are average to good. That is reflected in increasing cancer survival rates, fewer deaths from stroke and cardiovascular disease and other things. Even in recent years there has been a big uptake of vaccinations and a big reduction in the number of patients who contract MRSA. The Deputy will remember what a big issue it was in the past.

As the Deputy knows, there are two parts to the issue of waiting lists: outpatient waiting lists for those waiting for a clinic appointment and lists for patients awaiting surgery or a procedure, for example, hip, knee or cataract operations. In recent months we have really focused on inpatient day case surgical waiting lists, that is to say, for those awaiting procedures. In four of the last five months the number waiting for a procedure has decreased and we expect the figure to continue to fall. That is one of the areas in which we are making real progress. There are fewer people waiting for such operations. I accept that we have not made any progress on outpatient lists yet, but that will come.

To pick up on the Deputy's question on anticipatory reform, he will have seen the capacity review which was published only last week. It is very much an example of anticipatory reform. We are setting out the capacity increases we will need between now and 2031. We are not waiting until 2031 to do it. For example, 190 additional hospital beds have already been put into the system this year and there are now almost 10,000 doctors working in the public health service, the highest figure ever. We will continue to do this in the coming years.

On structural reform, the position of executive director for Sláintecare has been advertised. The Minister for Health has permission to establish a HSE board to improve the accountability of the HSE. I accept that that is a reversal of a previous policy, but bringing back a HSE board to bring about some accountability is the right thing to do. The boards of the hospital groups will be appointed quite soon and we are working on the GP contract. It will be difficult to do, but we are very keen to have a new contract. Cultural reform will be more difficult because in the health service it means taking on vested and local interests. Everybody wants to do it until they actually start to do it. We will need to see more tangible progress in other areas before we really get stuck into it.

Deputy Michael Harty

I thank the Taoiseach. As I stated, the fundamental question is one of reform.

There is a languid response to health reform from the Government as well as a lack of ambition and courage. There is also an amazing lack of curiosity concerning why we have an above average spend and a below average outcome in our health service. It is this lack of interest and ambition that concerns me.

Engaging in wrong policies with greater intensity will not bring about better patient care. The failure to have implemented any change eight months after the publication of Sláintecare means that it is too late to avert next winter's trolley crisis. When the HSE says that meeting its targets is challenging, it means virtually impossible. It is Holy Mary-type planning, where someone who knows that no miracle will appear is still hoping for one.

How could the Taoiseach go to Davos and say that our economic recovery is complete when there is a legacy of dysfunctionality in our health service, a housing crisis and pension and pay inequality and we at home know that our recovery is not complete and there are significant deficiencies in our public services? Where is the political will to reform our health service?

The Taoiseach

I think what I said in Davos, and the Minister, Deputy Donohoe, said it as well, was that our economic recovery was complete and that we were now expanding again as an economy, but that is not to say that our society has healed. We know the consequences of the lost decade - ten years in which virtually no houses were built, and ten years in which there was inadequate investment in the capital side of health care if not the current side. We are still trying to heal the society that was so damaged by that ten-year crisis, which was not caused by anyone on this side of the House.

I agree with Deputy Harty's fundamental comment. Fundamentally, the question is about reform. If we keep adding staff and adding resources, we will keep getting the same results, which are not good results. I do not agree that there is a lack of ambition or a lack of interest, but I accept that we are only going to be able to prove the Deputy wrong through results. I do not expect anyone to believe us until we start producing some real results.

On Sláintecare, I think we need to be realistic. It is an all-party committee report. It is a very good report. On the Deputy's advice, I have read it three or four times. It sets out what I think is a common vision that everyone shares in this House, for example, a commitment to public health, moving more of our health service into primary and community care, and separating or at least examining the separation of public and private practice. However, it is not true to say it is a comprehensive reform action plan or implementation plan for our health service. It is not that. The costings are evidently not correct and we need to get them done again. The report is silent on where the money should come from. It lists a million different options-----

An Ceann Comhairle

I thank the Taoiseach.

The Taoiseach

-----including anything one can imagine. It does not deal with a lot of the issues like those the Deputy just mentioned. It does not address at all the whole issue of performance, efficiency and where the money goes. It proposes more and more money, but it does not ask the fundamental question as to why we do not get a good return from the €15 billion that we are spending already. It does not deal with very thorny issues like reconfiguring and reorganising our hospital service, for example.

Dáil Éireann debate - Tuesday, 30 Jan 2018

Leaders' Questions

Dáil Éireann debate -
Tuesday, 30 Jan 2018