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

I welcome the Minister and Minister of State and the director general and other officials from the HSE. Having listened to the opening remarks one could be forgiven for thinking that we are, at times, living in parallel universes regarding what is stated as happening in the health services and what is actually happening at the coalface. There is evidence every day of the week in emergency departments throughout the country. Concerns for the well-being and safety of patients in emergency departments are highlighted consistently by front-line clinicians and other clinical staff to the point where we are threatened with industrial action. While we try to put the best slant on the situation we do have to accept that there are huge challenges facing patients and people who use the health services every day. This has an ongoing, daily impact on those who work on the front-line services across our hospitals. I am not trying to exaggerate, the figures are available and speak for themselves.

There is a daily increase in those who are waiting on hospital trolleys. It causes huge discomfort to many people who present for care. The staff are expressing genuine concern about the difficulties posed and about patient safety being compromised. Emergency consultants say that people are dying - not that they may die - and statistically there is no doubt that people are dying due to waiting inordinate lengths of time on trolleys in emergency departments.

We have situations where people are prepped for oncology treatment while in our emergency departments and on corridors. It has happened, for example, in Letterkenny and in Galway. For all of the advances that are claimed, the reality is very different when one goes to the coalface. I understand that the Minister has said he visited 16 emergency departments throughout the country and has seen the situation at first hand but there is no doubt that a little sprucing up is carried out when he visits these departments. That is the reality of life. People want to put their best foot forward and not let the side down. I am sure that when the Minister for Health calls to an emergency department every effort is made in advance to ensure that it is presented in the best possible light. This is only human nature and it is why I do not believe the Minister is seeing the coalface as it is, raw and jagged, on a daily basis.

I do not expect the Minister to announce the budget for 2016 but what I did expect last year was some effort in trying to bring forward a realistic budget to sustain the services as outlined in the 2015 planning. That has been sadly lacking also. We now have a budget deficit of approximately €0.5 billion, with carryover from the previous year of more than €630 million. We have a consistent problem of being incapable of assessing roughly, even to the nearest €100 million, the requirement for the health services. This is without any policy changes in terms of delivery of health care. The demographic make-up of our population has been ignored, scandalously, over the last years. There is no point in pretending. Year in and year out the budget is incapable of delivering the basic services.

Let us acknowledge and accept that, so that when we are funding the health services for 2016 meaningful Estimates are compiled that will underpin the services we commit to providing. We talk about demand-led schemes and so forth, but even with the increase in some of those schemes, the bottom line is that the Minister started off this year with €0.5 billion less than he should have had. He walked out of the Dáil knowing that. Mr. O'Brien probably knew it and most of the senior officials in the HSE knew it as well. It was simply unsustainable from the start.

If there is to be some redemption, the Minister should at least try to bring forward a realistic budget for the basic services. I accept there are still restraints on the Government. I do not expect the Minister to bring forward this year the €1.9 billion that is required to leap-frog our services to a sustainable level based on the demand, demographics and the expansion that is required across the services, along with the need for extra recruitment, capital investment and so forth. All of that is required, but we are still in challenging financial times. However, a realistic budget, at least, should be brought forward for basic service provision in our health services. Otherwise, whoever is Minister next year will be flapping around again next August and September trying to pretend that they will get to the end of the year when, in fact, they know from the start of the year that it simply cannot be done.

Regarding the emergency departments and overcrowding, we can only pass responsibility for so long. There are many reasons that there is overcrowding in emergency departments, including lack of capacity across the general hospital system. Even within the lack of capacity, the utilisation of that capacity and the blocking of a flow of patients through our hospital system, I cannot accept that enough is being done. Reference was made to the announcement that 300 extra beds would come on stream in December. I would bet any man or woman here my bottom dollar that by the end of the year all of those 300 beds will not have come on stream. If I am proven wrong, I will gladly give them my dollar.

The planning concepts that go into winter-proofing for the demand for our emergency services appear to be lacklustre, to say the least. Last December, there was a meeting of the new emergency department task force. It published its plans in April this year, but we now find we are back to where we were again, with over 600 delayed discharges, now planning the beds for November and December and cancellations of outpatient and day cases on a continual basis. That is not a recipe for improvement. It is no recipe for improvement to put one patient ahead of another in terms of elective surgery versus what happens in our emergency departments. I can understand it when an extraordinary emergency happens, but this is happening every day. It is no longer an unusual occurrence. There were thousands of cancellations of elective surgeries and day case and inpatient appointments in the first six months of this year. We have huge difficulties.

The Minister said he is a strong believer in universal health care. When he references reform of the health services, the establishment of the community health care organisations, the move to purchaser-provider split, the commissioning body being established and so forth, the single thing underpinning all of this is universal health insurance. Why did the Minister not flag what is a flagship policy of this Government in terms of universal health insurance, and why has there been no meaningful debate on it? On this side of the House we are of the view that there is now only a pretence about universal health insurance. Perhaps I could get clarity on what is the common purpose in the Government programme, a stated policy that universal health insurance would be delivered in 2016 and that the building blocks would be put in place in the preceding five years.

Finally, in terms of motivating staff to work across the health services, Mr. O'Brien is taking charge of the emergency task force. Obviously, he has vast experience because of his efforts in the special delivery unit, where he could see across all sections. With regard to the rolling of heads, how does he consider that in terms of motivating staff? Was there any investigation into how that e-mail leaked to the public? It is a rather distasteful e-mail. Has there been an investigation of how it fell into the public's hands, because it would appear that whether it was done by subterfuge or otherwise, it was obviously an intentional leaking to put it into the public domain?