Brian Cowen: The heat is on
On Wednesday 21 May, Brian Cowen was challenged in the Dáil to answer questions about palliative care services for older people and funding for mental health services. In the course of his reply to these questions, Brian Cowen was interrupted six times in his first response and then three times in his second response to the same questions, before he issued this threat: “For Deputy Reilly's attention, I can organise it so that every time his man [Enda Kenny] completes a sentence, I can have people roaring and shouting on this side if he wants.”
Because of the nature of the threat and the confusion about what had led up to the threat (Fianna Fail had claimed he had been interrupted on more than 40 occasions), we published below the full transcript of the exchange.
Deputy Enda Kenny: Since his appointment as leader of his party and his election to his new office, the Taoiseach has made several notable contributions with which I agree in respect of the delivery of outcomes and value for taxpayers' money. Nobody could disagree with those sentiments. However, what concerns me is the translation of that into effect. Before the Government arrives at a position where money is allocated, situations are assessed, reports are commissioned, objectives are set out and money is then allocated to achieve those targets and objectives. That is the normal procedure, going through the Department of Finance via the line Minister.
However, I will point to two examples where this process has slipped seriously. In 2006 and 2007, when the Taoiseach was Minister for Finance, the Government allocated €18 million and approved 130 posts in the area of palliative care services. Everybody in this House understands what palliative care means for elderly people who have a range of complex illnesses and may not have a good quality of life. Under the palliative care service proposals, the intention was that home care packages would be provided so that comfort, social contact, physiotherapy, chiropractory and other services would be available to older people in their own homes. Elderly people want to remain in their own homes for as long as possible. This point of contact with their home place is important for their comfort and mental well-being.
However, by May of this year, less than half the approved posts had been filled and only one in three in the three least developed regions. I see the Tánaiste is offering the Taoiseach some advice. I hope she is better informed of the figures in this instance than she was when she made her comments yesterday on the European Commission.
Deputy Mary Coughlan: That man got his answer.
Deputy Enda Kenny: Millions of euro which were allocated by the Government for legitimate objectives and targets in the palliative care area have disappeared. In other words, the money is not being spent for the purpose for which it was allocated.
That is not the only area in which this has happened. The provision of mental health services is an issue that has been raised by Deputy Neville on many occasions. Between 2006 and 2007, €50 million was allocated by the Government for the implementation of its mental health policy, A Vision for Change, but that money has not been spent accordingly. The losers in this case are persons suffering from mental illness throughout the State who are desperately trying to access psychiatric services. We are all aware of tragic cases which occurred in the last 12 to 15 months where people were unable to access psychiatric
services, with tragic consequences either for themselves or others.
In the case of both palliative care and mental health services, money allocated for legitimate objectives by the Government was not spent for that purpose.
The Taoiseach allocated that money and somebody took it away. The Minister for Health and Children has said on more than one occasion that it is wrong to spend money if we do not know where it is going. Why is it that in these two cases, money allocated was not spent for the purpose for which it was intended? Why was it diverted and on whose authority was that done?
The Taoiseach: One of the main issues we face in trying to reform the health service is ensuring that resources are not continually put into acute services but that we provide more for community services and improve the frontline services in communities. In regard to mental health care, change has been ongoing for more than two decades in terms of providing community based facilities and trying to end inappropriate placements for people in mental hospitals who, under modern psychiatric circumstances, could be far better treated in the community. This initially met with some community resistance because of people's lack of knowledge that such care settings could be established within residential areas. They have since proved to be a great success because of the support of community organisations which have helped people understand that persons in that situation are capable of having a more fulfilling life in the community than in institutional settings. That has been going on for some time.
A problem with our health system has been the level of resources taken up in the provision of acute services. Some 70% of the total budget is expended for this purpose. It is true that the full allocation was not expended in the areas of mental health and palliative care last year. In regard to palliative care, direction has been given to the management of the health service this year to ensure the allocation is expended in this financial year. This has meant an increased provision of service and a much increased allocation to the voluntary hospice movement which does-----
Deputy Jan O'Sullivan: The Taoiseach is referring only to the €3 million allocation for this year. What about the allocation for the last three years?
The Taoiseach: -----a tremendous amount of work in supplementing the statutory services that are provided in this area.
Deputy Jan O'Sullivan: What about the allocations for 2006 and 2007?
Deputy Pádraic McCormack: Show me the money.
The Taoiseach: There are budgetary pressures every year in regard to the health budget and managers have to manage the situation as they see it. In some cases, this has meant that some new development areas have not seen the level of expenditure in a given financial year as was originally envisaged. Working within budget allocations is a particularly difficult task, especially in the health service, but it is one that must be respected if we are to have sustainable improvements in the future. In the case of both mental health and palliative care, I expect the allocated moneys will be expended this year.
Deputy James Reilly: The health service management was given the money and spent it elsewhere.
The Taoiseach: In managing the health budget, managers must at times utilise particular allocations in order to maintain the existing level of service, which costs more money every year even before considering any new developments that are envisaged.
Deputy Dan Neville: There has been no extra money for mental health services.
The Taoiseach: The answer to the Deputy's question is that it is hoped the full amount will be expended on developments in the palliative care service this year. We want to see those developments take place.
Deputy Pádraic McCormack: Were the bonuses for HSE management paid? That is the question.
Deputy Enda Kenny: That does not answer the question. The Taoiseach was the Minister for Finance who made these allocations, and rightly so. Since his election as leader of his party and Taoiseach, he has pointed out that his priorities are health, delivery and outcomes. How can we have a situation whereby Ministers are allocated money by the Minister for Finance for specific targets and objectives which is not spent in those areas? That is the problem. As Deputy McCormack pointed out, the bonuses were not cut for managers and front line staff are not being recruited, with the result that on 13 May 2008 the Joint Committee for Health and Children heard evidence in respect of palliative care, which as Deputy Reilly regularly points out deals with people suffering terminal illnesses, the average waiting time for a hospice is eight days. The longest wait is 20 days but many of the people concerned do not have 20 days. The bonuses for managers are not cut, yet all the money allocated by the Taoiseach is unaccounted for and has disappeared. The Minister for Health and Children has said there is no point in spending money if one does not know where it is going.
I have had some difficulties with the Minister of State at the Department of Health and Children, Deputy Moloney, who is not in the House this morning, but I give him credit for saying on “Prime Time” that he was shocked at what was happening and the volume of money which was not being spent where it was allocated. He called a special meeting of the Joint Committee on Health and Children at which presentations were made by those involved in caring for the elderly and the hospice movement. He stated: “We do not have the authority to raise funds within this committee but we can ensure that funding allocated within the budget is spent within guidelines and headings.” He went on to give this commitment:
...that funding allocated in 2006, 2007 and 2008 will be spent specifically in the appropriate areas. Even though the two previous years have now passed, the funding that was not used then can be front-loaded for 2008 and 2009. That is what we are about. If we as a committee cannot deliver upon that we should not come back to this room for further meetings. We are putting it as starkly as that.
The Minister of State is the Taoiseach's constituency colleague. Can I take it that he has the Taoiseach's imprimatur, that the moneys which were not spent despite being allocated by the Taoiseach as Minister for Finance in 2006, 2007 and to date in 2008 will now be front loaded and that the Minister of State's comments as chairman of the joint committee will stand up so that front line staff in palliative care and mental health can receive the moneys allocated for a legitimate purpose which is of importance and great sensitivity to many families? Nothing is as frustrating as seeing Ministers announce money for a certain purpose only to find it has disappeared into a black hole somewhere within the HSE. Can I get a commitment from the Taoiseach that the words of the former chairman of the joint committee will be implemented to ensure these front line staff provide the service to which they legitimately aspire?
The Taoiseach: Every morning, the problem with the Leader of the Opposition is that his party has not yet supported one initiative in regard to health service reform.
Deputy Richard Bruton: Play the man, not the ball.
Deputy Brian Hayes: Answer the question.
The Taoiseach: For Deputy Reilly's attention, I can organise it so that every time his man completes a sentence, I can have people roaring and shouting on this side if he wants.
Deputy James Reilly: His Ministers keep coming out to say people are playing the man, not the ball.
An Ceann Comhairle: Deputy Reilly -----
Deputy James Reilly: He will not answer the question.
The Taoiseach: Every time I open my mouth, I hear something from the Deputy.
Deputy Brian Hayes: Answer the question.
The Taoiseach: I want to answer the question.
Deputy Pádraic McCormack: You are in Government.
Deputy James Reilly: Stop playing the man and start playing the ball.
The Taoiseach: The Deputy's problem is that he is not the Leader of the Opposition.
Deputy James Reilly: The Taoiseach's problems are myriad.
An Ceann Comhairle: Deputy Reilly, this is Leaders' Questions.
Deputy Enda Kenny: Answer the question.
The Taoiseach: Listen to me, I want to answer the question but I will make one point. If you keep that tactic up, I will make sure he will not be heard in this House.
(Interruptions).
The Taoiseach: It can be organised.
Deputy Michael Ring: The new statesman.
Deputy Enda Kenny: The Taoiseach will not silence the people on this side of the House.
An Ceann Comhairle: The Taoiseach without interruption.
Deputy Enda Kenny: I am not going to take that from any Member of this House. The Taoiseach will not silence the Fine Gael Party or any of its members.
The Taoiseach: I will not be shouted down by the orchestrated tactic engaged in by the Opposition for months. That will not work with me.
Deputy Pádraic McCormack: He is filibustering.
The Taoiseach: I want to answer the questions but if Leaders' Questions-----
Deputy Enda Kenny: You will not silence the people in this House.
The Taoiseach: -----is about you organising a shouting match, then you will not get answers.
Deputy Tom Hayes: The Taoiseach might treat Fianna Fáil backbenchers like that but he will not do the same to the House.
Deputy Brian Hayes: Will the Taoiseach just answer the question?
The Taoiseach: I will answer the question but I will not listen to that sort of nonsense.
Deputy Brian Hayes: Let us have it.
Deputy Tom Hayes: He will not control us.
An Ceann Comhairle: The Taoiseach without interruption.
The Taoiseach: If Deputy Kenny cannot control his own party, that is his problem. Leaders' Questions involve the Leader of the Opposition asking questions and me answering them.
Deputy David Stanton: What is the answer?
The Taoiseach: If I may reply without interruption, I will do so.
Deputy Pádraic McCormack: He has no answer and that is why he is filibustering.
The Taoiseach: The problem with Fine Gael is it wants it every way.
Deputy Paul Connaughton: Blame everyone else.
Deputy Richard Bruton: Can the Taoiseach answer the question?
The Taoiseach: Let me answer the question.
Deputy James Reilly: He cannot answer the question.
The Taoiseach: I am able to answer the question.
Deputy Richard Bruton: He is dodging.
The Taoiseach: I have Deputy Bruton coming in-----
An Ceann Comhairle: I have to interrupt. We must understand each other. This is Leaders' Questions.
Deputy Tom Hayes: He is making a joke of it.
An Ceann Comhairle: Deputy Kenny asked his question legitimately and the Taoiseach is entitled to reply.
Deputy Brian Hayes: Let us have it.
An Ceann Comhairle: Allow him to speak.
The Taoiseach: Without interruption.
Deputy Tom Hayes: He is unable to reply.
The Taoiseach: The Leader of the Opposition is complaining that insufficient money is being spent in the community on mental health and palliative care services. He made the point that we are making cutbacks to front line services. That is not correct.
Deputy Emmet Stagg: It is correct.
Deputy Pádraic McCormack: Those are the facts.
The Taoiseach: If Deputies want to hear the facts, an additional 3,500 front line staff are working in the health service this year compared to last year.
Deputy Emmet Stagg: The home help service has been cut everywhere.
The Taoiseach: The suggestion that there is a reduction in front line staff is incorrect.
Deputy David Stanton: What about the money?