Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

I welcome the opportunity to address this plan at last, as we had hoped to be in a position to address it prior to the Christmas recess. I welcome Mr. O'Brien's usage of the phraseology that was first submitted for consideration in a memorandum to the Cabinet indicating that "it will not be possible to fully meet all of the growing demands being placed on the health services". He has stated that twice in this evening's contribution, and it is the accurate and truthful position. It is very unsatisfactory and unacceptable that the formulation was changed to a phrase such as "very challenging in 2014 to fully meet all of the growing demands." This change happened not because of an assessment by Mr. O'Brien but because of political choice, and the more sanitised version was released by the Minister and published in the 2014 service plan. I expect the Minister to stand up for the health services and state very clearly to his Cabinet colleagues that €690 million in cuts in 2014 is unsustainable. I also expected of Mr. O'Brien that in the assessment he provided initially, he should have stood up to the Minister and insisted that the phraseology he employed in his informed position as director general should have stood. I welcome his utilisation of that formula here this afternoon.
There was a comment regarding the radio interview of 22 December, with Mr. O'Brien indicating that he was given no source for the proposed figure of €113 million in probity cuts to medical cards, since changed to €23 million in the service plan as presented. The figure of €113 million did not come from either the health department or the HSE. That raises real and serious questions as to the methodology of determining budgeting for the health services and planning on a year-to-year basis. I have repeatedly asked in the Dáil and here where the figure of €130 million in so-called medical card savings came from, so will somebody give the full, detailed and truthful answer? I note from the Minister's contribution that this is "pencilled in", but that is not acceptable. We want to know from where that figure came, and nobody need take any solace from the fact that we are now considering a figure of €23 million rather than €113 million. Many people who have depended on discretionary medical cards in particular have not retained their cards, and many others who would have hoped to receive their cards will not do so during the course of this year.
In the context of €4 billion having been taken from the health budget since 2008, with a further planned reduction in staffing, financial and human resources are being depleted. Mr. O'Brien indicated in his closing remarks the impact of the loss of approximately 12,500 people within the Health Service Executive. He did not indicate the projected cuts in 2014 and rather depended on the figure that might remain, but we will see a further 2,600 whole-time equivalents going in 2014. That is what the service plan projects. How can the health service, with all the financial cutbacks signalled, be able to carry out the level of service it currently gives, with patient safety in such high demand? There has been affirmation from both voices heard this afternoon, saying that such safety is the principal and guiding goal at all times. How can this be achieved if the Government continues to remove such a significant number of people from within the service? It is not sustainable.
I welcome the introduction of GP cards for children aged five and under but, unfortunately, we must consider the issue in the context of overall primary care cuts. By my calculation, they could amount to something of the order of €294 million. When can we expect the roll-out of the GP entitlement to all children aged six and under in the course of 2014? I note the Government is to take an additional €43 million out of the pockets of medical card holders in increased prescription charges, but when that figure is compared to the anticipated savings of some €50 million due to generic substitution and reference pricing, it puts into context just how pitiful the savings are with regard to generic substitution and reference pricing. The real potential is not being realised at all.
On that note, how do the Minister and the director general account for the failure of the HSE to move more quickly in setting reference pricing for medicines under the long-overdue legislation we passed last year? I have only to reference the recent Sunday Business Postarticle which details the figures, indicating that a range of drugs placed on the interchangeable lists by the Irish Medicines Board have not yet had reference prices set by the HSE. We are failing to realise what could be saved. Will an answer be given to the question? Do the witnesses accept that the entire process has been far too slow at a time when we need additional resourcing and funding? We are not moving quickly enough to realise the real savings that can be brought about. The money is to be taken from the pockets of medical card holders almost to an equivalence of what can be saved in this area, and that speaks volumes in my mind.
I am also very concerned that the service plan states that no additional funding is being provided for new nursing home places in 2014. That is a very worrying aspect, as there are already large waiting lists for places under the so-called Fair Deal scheme. This plan spells misery for thousands of people, and it is not that any saving is being made. There are approximately 600 people who may be holding beds inappropriately across our acute hospital network because they are unable to return home or access beds in the nursing home network.
Within the very short time available to us it is impossible to cover all of the critical areas. I wish to ask about the bilateral cochlear implants programme signalled for 2014, which I very much welcome. Nevertheless, the sum falls far short of what might have been required to set in place a full bilateral cochlear implant programme, not only for those waiting but also for those who may now present. Will there be a commitment to fully funding and rolling out that programme in 2015, and will the delegation confirm when the programme will be up and running in 2014? What level of provision of implants will there be and what number of young people is hoped to be catered to in the course of the year? Lastly, what is meant by €108 in "unspecified pay savings"?