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

I welcome the delegation, the Minister and the director general of the HSE. I wish everyone a happy new year. I welcome the two opening statements. It does not unearth anything earth-shattering in the context of the framework laid out for 2014 but shows it will be very challenging, as outlined by the director general. It also shows a big hole in the Estimate in underpinning the service plan in funding. We are talking about an underlying budget deficit of €419 million, coupled with savings to be identified of €619 million. In previous statements, the director general has referred to €1 billion as the overall adjustment required to live within the budget figures announced. That was subsequently deleted but it does not get away from the fact that we are facing a budget reduction of €1 billion. I would like some clarity on why the €1 billion figure mentioned in previous times has now been dropped, even though the only additional funding I can find is the €47 million identified in the Revised Estimate. The director general said previously that it will not be possible in 2014 to deliver the plan and now he says it will be very challenging. I find it hard to believe that the sum of €47 million moves it from being almost impossible to very challenging in the overall context of a €13 billion budget.
We were led to believe there was uproar at Cabinet when the first draft service plan was presented by the Minister for Health to the Cabinet. The reason we were told or were led to believe was that Ministers had concerns about the wording of the foreword signed off by Mr. O'Brien, which stated

It will not be possible in 2014 to fully meet all of the growing demands placed on the health services. In particular, the level of investment required to meet many of the critical service priorities or respond to many of the demographic pressures identified.

That was subsequently amended to read:

It will be very challenging in 2014 to fully meet all of the growing demands being placed on the health services. In particular, some service priorities and demographic pressures may not be met.

Twice in Mr. O'Brien's presentation, he has gone for the original wording and I find it strange that it was taken out of the original wording even though Mr. O'Brien has twice mentioned the exact wording that was deleted after political discussion at the Cabinet table. I find it strange and I wonder why it is the case.
It is identified that there will be €108 million of unspecified savings and that there will be an independent verifiable process to assess how the savings will be achieved. How long will it take to identify where the savings will be realised and whether they can be achieved? If they cannot be achieved, other areas must suffer to ensure we come in under the budget targeted in the HSE service plan. When will the savings be identified and, if they cannot be identified, will it require a Supplementary Estimate? Will funding that has been clearly identified in the HSE service plan be withdrawn, as has happened in previous times in respect of disability and mental health? These areas were targeted in previous times when the books would not balance. It is important to get clarity on this point very quickly.
Fianna Fáil welcomes the change in respect of the probity probe into medical cards. It never ceases to amaze me that it could have been included in the original Estimate proposals because it did not make sense. I do not believe there are so many medical cards in circulation that should not have been in circulation. If that is the case, it is an indication of sloppy awarding of medical cards. We welcome the rollback. The Minister also referred to medical cards and how people are entitled to them. No one disputes that everyone entitled to a medical card under the income guidelines set out in the 1970 Health Act will receive a medical card. These people are legally entitled to them but the key area concerns discretionary medical cards. By any adjudication, the number of medical cards and GP discretionary cards has decreased from 96,000 to 57,000 over the past three years. There is a targeting of discretionary medical cards, even though we are consistently told it is not the case. Most Deputies and every organisation I encounter say it is almost impossible for some people, who had previously been awarded discretionary medical cards, to get medical cards. We must revisit this.
The Minister talks about reform continuing apace. I must question that in view of the fact that we are now facing into the fourth year of this Government. The White Paper on universal health insurance has not been published and it is a key underpinning part of any potential further reform. The Minister talked about setting up hospital trusts and how money follows the patient. This is an important area and at this stage we should see what is a central plank of Government policy in terms of the reform of the health services and how they are funded.
Consultant-led clinical care teams are a central plank in the delivery of health care. Where there are consultant-led clinical care teams they work very effectively. We must acknowledge that. Anecdotally, I have heard of a number of incidents where it is more difficult to recruit consultants. Is that the case? Is it difficult to attract consultants to this country and difficult to retain consultants? If so, why is this the case? We all know we must increase the number of consultants in the health services to ensure we have delivery of care.
Mental health is grossly underfunded.

No matter what way we try to argue or spin this issue, or whether one Minister of State had to threaten to resign to get €20 million included in the HSE service plan, the bottom line is that it is grossly underfunded. A Vision for Change is effectively being used as a mechanism for closing services as opposed to enhancing them. We must genuinely consider that issue. If services are to be reduced in an area, the full recommendations of A Vision for Change should be implemented rather than the parts recommending the reduction in acute or community beds and other areas. A Vision for Change should be fully rolled out rather than using it in a guise in order to close services.