Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome the delegates. I, too, welcome the Taoiseach's announcement of changes to the personnel investigating the tragic death of Ms Savita Halappanavar, as I was very concerned when I heard about the composition of the panel. I do not want to cast aspersions against or question the integrity of the eminent individuals originally appointed to the investigation team, but I believed they were being compromised almost immediately by being put on the panel. It is regrettable that the original decision was made, for a number of reasons. As the Minister rightly stated, we want to get to the truth of the matter in a manner that is completely impartial and independent. We were told there would be discussions with Mr. Praveen Halappanavar on the investigation. If there had been, those appointed to the investigation team would not have been appointed. There have been strong expressions of concern about the composition of the team. Mr. Halappanavar has expressed views publicly through his solicitor.

There are a number of reasons this issue is very important. The first is the tragic death of Savita and our desire to find out exactly what happened. There ought to be absolute independence to give confidence to everybody using or who will use maternity services. By and large, we have an excellent maternity system, staffed by the most highly qualified and eminent individuals, be they consultants, midwives or other nurses. It behoves everybody to ensure there is an impartial, independent investigation for everybody concerned, including the family, service users and service providers.

I was amazed and completely disappointed at the outset that people could compromise the investigation by including in the investigation panel individuals who had close associations with the personnel working in Galway. We must be conscious of the fact that many staff are very upset about what happened. We must take this into account. Therefore, I welcome the change in personnel. We want an expeditious, impartial and independent investigation.

With regard to the opening statements of the Minister and Mr. O'Brien, I have major concerns about some of the issues raised and some of those omitted owing to time constraints. There is an overrun of €399 million and we are asking the insurers to assist with the cash flow of the Department of Health and the HSE in terms of up-front payments for treatments provided. Clearly, there is a major difficulty with respect to the sustainability of the budget and how it is put together in the first instance. A huge budget deficit is to be carried over into next year when savings of an inordinate order have already been identified as necessary. Clearly, this year's HSE budget was unsustainable from the word go.

Reference was made to full cost recoupment for private patients in public beds. This would obviously have placed a considerable burden on insurers and, ultimately, premium holders. Consider the escalating price of private health insurance. There is always price inflation in medicine and it normally runs well ahead of the consumer price index. Clearly, there is a considerable problem. Major difficulties are encountered by ordinary families in that they are simply unable to pay the increasingly higher premiums demanded by insurers.

Reference was made to the next step, namely, the strategic framework for health reform and the move to universal health insurance. What is happening goes against the grain of everything the HSE and the Department of Health should be trying to do, that is, encouraging as many people as possible to take out private health insurance, at a sustainable and affordable rate, according to the principles of risk equalisation and community rating. People are giving up cover all the time. Younger people are dropping out, thus placing the burden of community rating and risk equalisation on older generations. This is simply not sustainable. With regard to the move towards universal health insurance, the Minister must take one step forward to try to address the haemorrhage of people from private health insurance which is placing additional pressure on the public health system. The move towards universal health insurance is aspirational because every day people are downgrading their health insurance plans, thus creating considerable extra difficulty.

The issue of home helps is another area to which reference has not been made. To be clear, there is no relationship between what the Minister and Mr. O'Brien are stating in public and what is happening on the ground. I genuinely mean this as what is happening regarding the withdrawal of services for those who rely on home helps simply does not equate with the press releases being sent out stating no one will be denied a service. Thousands of people are being denied services that would sustain people at home for a longer period. Even at this late stage, the Minister and Mr. O'Brien should try to revisit this issue. I acknowledge the sum involved is €8 million and that the health budget is under significant pressure but there have been repeated cases of people simply not being able to access a home help service they had heretofore. This is putting significant pressure on individuals' ability to remain at home, on their quality of life and on families who are trying to sustain people at home and out of long-term residential care. Clearly, the Minister and Mr. O'Brien must address this issue because what is being stated publicly and what is happening on the ground are at absolute variance.

On the broader issue of the strategic framework for health reform, this could yet be the best seller for Christmas. However, it will be found in the fiction department because there are neither costings nor an outline of precisely how the Minister intends to achieve his goals contained in the strategic framework. For example, the Minister speaks of universal health insurance and in the strategic framework, he already has identified a form of universal health insurance. At the same time, however, members await the White Paper on universal health insurance as to the model on which it will be based. If a major shift is envisaged in how we fund health services and how universal health insurance is to be introduced, it clearly will be desirable for the people, the Department and the Legislature to have a discussion on what form of universal health insurance is being proposed. While a White Paper is forthcoming, at the same time we already have in place a strategic framework for universal health insurance. There is a difficulty with people trying to buy into this particular framework document when they are not even quite sure of the funding model that will be available to fund the move to universal health insurance. The cart certainly is well before the horse for this proposal.

The Minister referred to a move to primary care, investment in primary care and what flows therefrom. How far down the road have we gone regarding the issue of access to GPs and free GP care? As far as I can ascertain, we are no further advanced in providing access to free GP care than was the case two years ago. There were legal problems and complications in respect of the long-term illness scheme but, to date, there has been no major move in that regard other than "Live horse, get grass" in 2013. I fully understand the budgetary constraints on the health services but, clearly, the move to universal free GP care and then to universal health insurance was a very important stated policy on which we have not progressed very much further.

Finally, I again ask who is responsible for the budget? Is the Minister for Health or is Mr. O'Brien responsible in respect of accountability for the budget itself and for ensuring the reining-in of the deficit?