Ceann Comhairle, I welcome this opportunity to give an account to the Dáil of my actions in April 2019 in relation to the contract negotiated between the Government and GPs as represented by the Irish Medical Organisation (IMO).
I welcome the opportunity to set the record straight, refute some allegations against me and to apologise for an error of judgement.
At the outset, I want to share with the House my motivations throughout this. I am a doctor by training and a qualified General Practitioner. So is my father. I grew up over the shop which was his surgery in Blanchardstown. I believe that the solution to many of the shortcomings in our health service lies in developing primary care and community care, and at the heart of this is our General Practitioner.
Hard-working, committed, dedicated people, rooted in their community who already provide high quality, easily accessible medical care with no waiting lists 24/7 – 365 days of the year. They are willing to do more. All they ask is that they are properly resourced and supported and it’s the role of Government to enable this.
For most of the last decade, as a consequence of the financial crisis, we were forced to do the opposite and resources were taken away from General Practice and Community Care.
This had a detrimental impact on our Health Service as a whole and led to many newly qualified GPs, including many I knew personally, losing heart and deciding to emigrate. Only from 2016 onwards did it become possible to change this.
As Health Minister, alongside Minister of State Kathleen Lynch, I was able to secure agreement on a new contract with GPs to manage diabetes in the community rather than in hospitals. It was a major step forward that has improved care for tens of thousands of patients.
We also made contraceptive implant devices, first line investigations like 24 hour blood pressure monitors and other services more available than before. This was just a prelude of what could be achieved through a wider contract if we had had the budget to do so.
We also negotiated a new contract with the IMO to extend free GP care to all children under six and all seniors over 70. While the latter was well received, free GP care for the under sixes was not and it was controversial and caused real division among GPs, and the medical community.
It was broadly supported by the IMO which represents all doctors including GPs but not by another organisation representing GPs only, the NAGP, which actively campaigned against it.
Rivalry between the organisations was often bitter, and it made agreement harder to achieve and held back progress.
The NAGP wanted to be at the table. Some GPs were members of both organisations, some of neither. Ultimately, Government decided to deal with the IMO alone, as our long-standing negotiating partner and ICTU affiliate. The Opposition was very critical of this at the time.
We committed, however, to keep the NAGP engaged, involved and informed as to the progress and outcome of negotiations. As the Minister for Health, Simon Harris, informed the Joint Oireachtas Committee on Health in February 2019, while the negotiations were with the IMO ‘there was a role for the NAGP to play in terms of being consulted and involved’.
In a Government memo, going back to March 2018, the Cabinet was informed that there would be “formal consultation” with the NAGP.
Ceann Comhairle, it is important to understand that General Practitioners are not employees. They are contractors, self-employed and have an individual entitlement to accept or reject any contract regardless of any ballot.
Any agreement made by their representatives is not a collective agreement in the normal sense. In fact, such negotiations are more correctly termed consultations. Each GP has to be convinced individually to sign up.
In 2015, the campaign led by the NAGP against the Government-backed under sixes contract was very disruptive and resulted in the service not being available universally across the country for quite some time. I wanted to avoid a repeat of that in 2019.
When I became Taoiseach in 2017, I said that I had unfinished business in health. I meant it. And I still mean it.
And among my priorities was to finish where I left off in the Department of Health.
I wanted to use the influence of the Taoiseach’s office to secure a new contract with GPs, to reverse the FEMPI cuts in return for a commitment to provide new and better services in the community for more patients free at the point of use.
It would be a big step forward towards achieving universal healthcare in Ireland which I believe in, and while we might disagree on the model, I know almost everyone in the House agrees too. It would also make general practice viable again.
As Taoiseach I was fortunate to have an active and energetic Health Minister in Simon Harris who shared that vision and in Paschal Donohoe, a Minister for Finance and Public Expenditure who knew that this was a political priority for me and was willing to find the funding to make it possible.
I took an active and personal interest in the talks, was frustrated at times when they were not progressing quickly enough and kept in personal contact with a number of GPs who I felt were opinion leaders during all of this.
I was determined to get the deal done and to ensure it secured universal acceptance across the GP community.
I wanted to get it implemented and then move on to the next items on the agenda like free GP care for children under 12, as well as further services being moved from the hospital system to the community like minor surgery and ante-natal maternity care.
So, this was my sole motivation all along. I wanted what was best for general practice, for patients, and for the public. The suggestion that in any of my actions, that I had anything to gain personally in any way is false, without foundation and deeply offensive.
Ceann Comhairle, the facts are as follows:
Following lengthy negotiations, an Agreement was reached on April 3rd and in the words of RTÉ Health editor, Fergal Bowers, the ‘fine details’ were publicly announced on Friday, 5 April 2019, by the IMO. The details of it were extensively described in a Press Release issued on that day. There was also a five-page document issued by the IMO entitled ‘Summary Information’. This set out all of the financial details as well as anything that could be considered ‘commercially sensitive’ – €120m extra in fees, a 10% pension contribution increase, enhanced maternity and paternity leave, €80m for chronic disease management, and a detailed revised fee schedule.
The IMO had struck a very good deal for their members and publicised that fact. I am putting this document on the record of the House today.
The following are the words of Dr Padraig McGarry, Chairman of the IMO GP committee on the 5th April 2019:
“The Irish Medical Organisation (IMO) has announced details of a negotiated agreement with Government which secures €210 million in increased funding for General Practice over the coming years.
“This is an important step towards investing in General Practice and valuing it as a vital part of the health service. It will do two things: restore the draconian cuts imposed on GPs and bring new and much needed funding to deliver new services to patients in the community”
I am putting the full statement on the record of the Dáil today.
Similarly, on Saturday, 6 April 2019, the HSE issued a statement entitled ‘GP Contract Launch’. ‘Launch’ was the term used by the HSE.
Anne O’Connor, interim Director General publicly welcomed the agreement on GP contractual reforms. I am putting her statement on the record of the House.
In addition, at a public event in a Primary Care centre on the same day, Saturday, 6 April, the agreement was welcomed and endorsed by me as Taoiseach and the Minister for Health. I am putting this statement on the record of the House.
On Tuesday, 9 April, a memo was brought to Cabinet by the Minister for Health informing the Cabinet, and I quote, that ‘engagement had concluded’ with the IMO. The matter did not return to Cabinet as no significant changes were made between then and its formal publication on May 17th though there were minor ones.
Thus, the fact is that an Agreement had been reached, and the nature of that Agreement was not something that was an official secret, highly confidential or commercially sensitive after 6 April. On the contrary, all the salient information was in the public domain, and was being discussed at public meetings that GPs were attending.
I know that there were calls in the Dáil at the time for the full terms of agreement to be published.
Deputy Louise O’Reilly said ‘we should have had it the day after it was agreed by the IMO’. Deputies Alan Kelly, Stephen Donnelly and Roisin Shortall were all critical of the fact that it had been agreed but not published. Other deputies mentioned the possibility that GPs who were members of the IMO might see it before those who were not and pointed out that some GPs who were not a member of either organisation might be at an unfair disadvantage.
In the normal course of events, agreements are published within days if not on the night they are made. I think, as the Taoiseach said the other day, on reflection it would have been better if that practice had been followed here.
I fully respect, however, that the IMO wanted to do it differently and wanted to hold meetings around the country to consult and engage with their members before doing so.
For my part, as Taoiseach, and in my capacity as Head of Government, I was keen that the Agreement should be well received by the General Practitioner community as a whole, and not just those who were members of the IMO.
It was a good deal and I wanted it to be universally accepted. In particular, I wanted to avoid a repeat of the problems we had getting the under sixes agreement implemented.
As I said earlier, General Practitioners are not employees. They are self-employed contractors and they had an individual entitlement to accept or reject it. Indeed, there are some that are still operating on very old contracts to this day having chosen not to accept those negotiated in recent decades.
At this time, Dr Maitiú Ó Tuathail was the President of the National Association of General Practitioners (NAGP). It claimed to have 1,200 GPs among its members.
I posted a copy of the Agreement to Dr. Ó Tuathail between the 11th and the 16th April 2019, most likely 15th or 16th.
I did so on a confidential basis believing publication was imminent anyway. I wanted his opinion on it and hoped that in seeing how favourable a deal it was, it would remove or mollify any opposition from that organisation. I wanted him to see that there was nothing in the Terms of Agreement that was contrary to what was publicly announced. And there was nothing in it worth opposing or agitating against.
In the end, the deal made by the IMO was demonstrably good for General Practice and the NAGP did not oppose it and, in any case, the organisation fell into decline very soon after due to internal issues.
Providing them with the information did not confer any advantage over the IMO or anyone else. Indeed, arguably, anyone affected by it should have been given access to it as soon as agreement was reached or shortly thereafter. This is the normal practice.
The Government had publicly committed on multiple occasions to keep the NAGP informed as to the progress and outcome of negotiations. Indeed, the opposition went further and argued that we should have included them in the talks from the start.
In providing a copy of the agreed and publicly announced Terms of Agreement, I was honouring a political commitment previously made by the Government which I led, including commitments given here in the Dáil.
The question at that point was a different one: how to get GPs to sign up to it quickly and en masse. This was my objective.
It has been alleged that there was something improper, perhaps even criminal in my connection with Dr. Maitiú O’Tuathail. This is not the case.
It has been reported that he is, quote, ‘a Varadkar cheerleader’. Yes, there are examples of his public support for me during the period, but there are also plenty of the opposite. For example, 13th April 2019, in the middle of this timeline, he publicly attacked the Government for providing more GP visit cards calling it a shameful ‘vote-getting exercise’.
He went on to describe the policy of the Government that I led as ‘the biggest con job in the history of the health service’. Not exactly cheerleading.
This was someone who was President of the NAGP who I wanted to be in support of the agreement and not vehemently opposed to it.
Ceann Comhairle, it won’t surprise you to hear that Ministers have lots of numbers in their phone. Prime ministers have each other’s phone numbers and speak informally in-between official meetings. Occasionally we even exchange what are termed ‘non-papers’. In fact, any party involved in talks relating to Northern Ireland would be very familiar with all of this.
The same goes for informal contacts between Ministers and union leaders, business leaders and indeed TDs and Senators. There is nothing inappropriate about informal contacts of this nature per se. In fact, little would get done without them. And we all know it.
Ceann Comhairle, sometimes people like to exaggerate the nature of their relationships, to inflate their own influence, or to claim to speak for a person when they do not. Friends and acquaintances and supporters may claim to be closer to you than they really are. This is clearly a big part of this story.
Ceann Comhairle, if we are honest, most of us here are familiar with this phenomenon. I am always willing to help people, just as I am willing to help a constituent in need but I never do so in a way that confers, on them, any sort of special treatment or advantage. It is never something I have been accused of before.
Having said that, I do accept that the provision of the Agreement by an informal communication channel to the President of the NAGP, in the way that I did was not good practice.
I regret that I did not ensure that it was provided in a more appropriately formal manner. It was an error and one I accept sole responsibility for.
I know it has caused people to question my judgement. But I hope, having heard my explanation, no fair-minded person will question my motives or integrity.
I do regret it and I am sorry for the controversy and annoyance that my actions have caused including to members of the medical profession, the IMO, my colleagues in Government and to the House.
I know I have made mistakes as a Minister and when I was Taoiseach.
I have tried to learn from them.
There are things I wanted to do and failed. And even with the things we did achieve, I wonder could we have done more.
Over my career I have been guilty of errors of judgement.
But I have never been motivated by a desire for selfish financial gain or from motives corrupt. Not for a minute.
My guiding principle today is the same as it was when I entered political life. To serve my country to the best of my ability. To make a difference while I have an opportunity. To reward the enormous privilege of being elected to this House, by helping to improve the lives of all our citizens.
I knew the new GP contract would make a difference and help some of the most vulnerable in our society who needed it the most. I made an error of judgement in trying to achieve that result, motivated by the very best of reasons, but there was nothing selfish or dishonest let alone corrupt or illegal in what I did.
Ceann Comhairle, I have been asked to give a full and detailed account of my actions to Dáil. I have done so. I have been asked to set out the timelines, I have done so.
I have also been asked about the ‘full impact’ of my actions. There was no impact. Certainly no negative one. The deal was done.
It was well received. And was accepted almost universally by GPs. It is now a reality and is being implemented providing better, more accessible care to more patients in the community.
And this is what really matters.
I am happy to answers the Deputies’ questions.
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