Wednesday, 6 October 2010
Dáil Éireann Debate
Deputy Enda Kenny: The people of this country have woken up to another scandalous list of waste, this time in the HSE. It seems as though the culture that has been perpetrated by the party of the Taoiseach over the years has infiltrated every single organisation. It is a case of see no waste, hear no waste, speak no waste, whether it is FÁS, the HSE, Departments or banks. Public Ireland is now divided against private Ireland.
Five years ago, the Taoiseach told us that the last major episode of waste in the HSE, the famous PPARS debacle, would be the last one, and that there would be accountability and transparency. It is ironic that the Minister for Health and Children has actually commended the HSE on finding the rotten apple in the barrel yet again. This is a scandalous situation. There is no accountability and no transparency, and nobody is being brought to book, yet last week we saw a picture of a young man being led away in handcuffs because he could not pay a fine of €200 or thereabouts.
The evidence from medical personnel and those in the Medical Council is that cuts in front line services and cancellation of necessary operations will put lives at risk, with people not being examined for cancers and other serious illnesses. It appears the Government does not give a damn that this litany of obscene waste will continue and that Irish taxpayers will be made to pay for it. Does the Taoiseach believe these cuts are putting people’s lives at risk?
The Taoiseach: The Minister for Health and Children was simply pointing out that an internal audit by the HSE had uncovered this situation, which has been referred to the Garda. That is an exercise in accountability. The Comptroller and Auditor General is also dealing with the matter, and it will be discussed by the Committee of Public Accounts. When the full facts are provided in that forum, discussion can take place in the normal way and the accountability mechanism of the committee can take effect.
The Taoiseach: As the health service has a budget of €15.2 billion, it is important that every aspect of that funding is used for the purpose of providing health services to the people of the country. No Government, or responsible manager, could condone any waste of public funds. It must be dealt with, and is being dealt with.
The Taoiseach: All procedures will be followed so that the full facts may be known. The problem is with administration expenses and other expenses that were drawn up for a programme intended to provide career paths for up to 32,000 care assistants and others in the health service, 9,000 of whom have already participated. The programme itself, and its use by staff to enable them to upgrade their skills and move along a career path through the various grades of the health service, is in itself a good thing. If there are issues with regard to administrative aspects and bodies that obtained grants in aid, that is a matter that must be further investigated based on the internal audit thus far, which should be allowed to proceed.
The Taoiseach: As I said, we are spending €15.2 billion on the health service, which represents almost half of the total tax take this year. There is a large spend on health — quite rightly — but we must make sure it is provided in the best possible way. There have been real improvements, including in the provision of cancer services, the number of people undergoing day-case surgery and the number of people coming through the health service generally. There are many people whose experiences of the health service have been favourable. There are also areas in which there are acute service pressures. Deputies will know from their own work where that may be the case. However, there are many people whose interactions with the health service are good, and that should also be acknowledged.
To return to the point being made by Deputy Kenny, €1 billion less was spent on the health service last year, €650 million through reductions in labour costs and €350 million through efficiencies identified by the HSE in the course of this year. Next year further savings will be required because the budgets must be tailored to the amount of money that is coming into the Exchequer. We had that discussion yesterday. The Croke Park agreement can minimise any impact on front line services by ensuring that all changes in work practices are agreed. Action plans for health and other areas of the public sector are being worked on at the moment. As soon as estimates are completed, an intensive effort will be made by all partners in health who are prepared to sit down and find a way forward that minimises the impact on front line services, recognising that there are limited resources available.
Deputy Enda Kenny: The question I asked the Taoiseach was whether he believes the cuts in front line services are putting people’s lives at risk. He did not answer that question. I have here evidence from the chairman of the Medical Council in the mid-west, who says that if the cutbacks are implemented in the way the Minister is talking about, cases of cancer will not be diagnosed, cancer patients will not be treated and people’s lives will be put at risk. It is five years since the Taoiseach said the PPARS scandal would be the last in the HSE. He has turned a blind eye to the back-office bureaucracy, with the number of grade VIII managers jumping from six to more than 700. He has turned a blind eye to the advice of the former chief executive, Professor Brendan Drumm, who said last July that HSE bureaucracy should be cut by 30%. He has turned a blind eye to the €100 million spent on consultants’ reports that are lying on shelves with nothing being done about them. A blind eye was turned to the €121 million that the HSE spent on taxis over four years. These were either mass missions of mercy or an indication that public money met Wall Street, where money never sleeps.
Deputy Enda Kenny: It is about time that somebody on the other side acknowledged that the committed and dedicated people who work in the HSE should be thanked for the work they do in the face of this obscene waste of money. They want to continue providing front line services.
The Taoiseach mentioned the Croke Park agreement. I note the suggestion made today that 6,000 voluntary redundancies would be sought in the HSE. Can he confirm whether it is the intention of the Government and the HSE to seek the 6,000 voluntary redundancies which were referred to as fact in today’s newspapers? In view of this appalling scandal and the litany of waste that runs through FÁS, banks, Departments and, now, the HSE, where nobody is accountable, does he agree it is time to dismantle the HSE in its current structure?
The Taoiseach: The centralisation of services in the HSE, and particularly acute hospital services, was a far better approach than the regional system was ever capable of providing in view of the need for a properly organised national system of primary, secondary and tertiary care.
The Taoiseach: It is not a question of blind eyes being turned. As I have stated in this House in regard to many debates on health, the Opposition consistently argues for the status quo rather than accepting the need for reform. Every reform we propose is fought tooth and nail because various interests have a view of it.
The Taoiseach: It is not correct to say a blind eye is being turned to these matters. The agreement reached in Croke Park last June provides us with the means for redeployment, which is necessary, and all the practices and flexibility we need in order to deal with issues which could achieve efficiencies and savings without affecting patients’ quality of care. In terms of skills mixes, ratios of staff, etc., there is a range of detailed industrial relations issues which can be resolved and the motivation and belief exists on all sides to address them in view of the need for a sustainable level of service provision and the fact that budgets are not limitless. All partners in health have acknowledged these matters.
Rather than portraying the situation as incapable of reform or seeking to hold up change, many people in the service are seeking to introduce change on the basis of the agreement negotiated by the Government in Croke Park. This offers us the mechanism by which all these issues can be addressed in a structured and organised way. That is the challenge with which we wish to engage intensively in the coming weeks and months.
Deputy Eamon Gilmore: Deputy Kenny rightly referred to the pattern of waste in the HSE over which the Government has presided for many years. The latest example of this is contained in the internal report presented to the HSE on the audit of the SKILL programme administrative expenditure, which will be considered by the Committee of Public Accounts tomorrow. I hope there will be full accountability from the HSE and all the other organisations involved in that episode.
I want to draw the Taoiseach’s attention to another area of waste in order to get some answers from him. I refer to the report issued yesterday by the Department of the Environment, Heritage and Local Government, which tells us there is no purchaser for the electronic voting machines and that the State is not going to recoup any of the money wasted on that expenditure. At a time when people are being asked to pay more and endure further cuts as a result of the Government’s mismanagement of the economy and the banking crisis, it is increasingly unacceptable that such waste continues without being accounted for. The electronic voting machines were purchased in 2004 by the Government and €50 million was spent on them but they were never used. It was part of a pattern of waste which was taking shape at that time. However, this episode did not have to happen because the Labour Party, Fine Gael, information technology experts and academics warned the Government in advance about wasteful expenditure on a voting system that would not work, was unreliable and should not be proceeded with.
Deputy Eamon Gilmore: I want to ask the Taoiseach two questions in regard to this matter. First, will he confirm to the House that the €50 million is gone, that we will not see it again and, as the spokesperson from the Department of the Environment, Heritage and Local Government stated yesterday, the money will not be recovered? Second, will he finally acknowledge this was an appalling waste of money, a fact which nobody in Government has ever acknowledged?
The Taoiseach: The costs associated with the e-voting machines are of the order the Deputy pointed out and clearly they will not be used in this country. The question of their disposal is under consideration. It is true that they represent a loss to the Exchequer, which is a great disappointment. The decision not to proceed was taken by the Government on the basis that it would not be possible to get all-party agreement for the e-voting machines.
Deputy Eamon Gilmore: That is not true. The decision was not taken because all-party agreement was not obtained. The decision was taken because an expert group set up to examine whether the system was reliable found it was just as, if not more, dodgy and unreliable to use electronic voting machines, as both the Labour Party and Fine Gael pointed out when the exercise began. That is why the machines could not be used. The system was unreliable and it had to be abandoned. It had nothing to do with all-party agreement. It was a waste of money which cost the taxpayer €50 million.
This Government thinks in billions of euro, so €50 million may not amount to a lot for it. However, €50 million is the amount which it will get back over two years on the 50 cent prescription charge it is imposing on medical card holders. The prescription charges will amount to €24 million per year. For the next two years, every medical card holder in this country will be paying 50 cent per item when filling a prescription in a pharmacy in order to pay back the €50 million the Government wasted on electronic voting machines. No Minister was ever held to account for this. Nobody was ever sacked or chastised. The money was wasted. It is about time that the Taoiseach or somebody in the Government had the good grace to stand up, say that they made a mistake, the money is gone, apologise——
The Taoiseach: I stated in my first reply that the €50 million will not now be put to use because those voting machines will not be brought into operation. To associate that with costs in the health service is a political point the Deputy wants to make. We have had to consider prescription charges due to the increasing cost of our drugs bill in this country, which has gone from €300 million to almost €1 billion over the past number of years.
The Taoiseach: The expert group found that the voting machines were fit for purpose and that the software could have been reworked to achieve it, but a decision was taken by the Government not to proceed along those lines because it became a matter of public confidence as to whether the machines could be used here.
The Taoiseach: The number of spoiled votes that are allowed for under the current manual system is greater than the difference between the winning and losing of the last seat in a constituency. The purpose of e-voting was to eliminate that error and to provide a better way of dealing with it. Regardless of the fact that e-voting has legislative support in the House and that the expert group found that the software could have been reworked, the Government decided not to proceed with e-voting, and it is true that this is at a loss to the Exchequer.
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