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

I welcome the Minister and Mr. Breslin. The Committee on the Future of Healthcare spent considerable time drafting the Sláintecare report. I appreciate the work done by the Chairman and secretariat in providing support to the committee, members of the committee and the witnesses who appeared before it. The report includes timelines to which we hope the system will adhere, regardless of who is responsible for doing so in the period ahead. This should not be a matter for individuals as it requires corporate buy-in by the public service administration to ensure reform is seamless, regardless of which party is in government. This is especially the case given that the agreement on Sláintecare was reached by an all-party committee. The difficulty we have had for many years is that health policy has been jagged, to say the least, in terms of political parties and manifestos.

One could be forgiven for blaming the political side for the direction the health service has taken and the fact that policy was reversed or changed or retrenchment took place. This is a difficulty for those who are implementing policy. That being said, we cannot completely exonerate those on the policy side of the Department with regard to the implementation, not only of the Sláintecare report but also of previous policies.

The Chairman referred to the "Prime Time Investigates" programme broadcast last night. The programme showed an abject failure in policy and to ensure contracts were enforced. The director general of the Health Service Executive, Mr. Tony O'Brien, stated in a confidential email to the then Minister for Health, the current Taoiseach, that large voluntary teaching hospitals were in some instances breaking the rules in how they went about recruiting consultants. The contract introduced in 2008 set a limit of 20% on the percentage of patients most public hospital consultants could treat privately. However, in his email, Mr. O'Brien stated the percentage division between public and private was "a farce in practice". This email was sent to the Minister's predecessor.

None of the members of the joint committee will have been surprised by last night's "Prime Time Investigates" programme. We were shocked, however, to use the words of the Minister, by how immoral, unfair and brazen some of these individuals were. While some people may be immoral and brazen and their behaviour will have unfair consequences, the bottom line is that contracts must be enforced and the Department and HSE are failing to do so. The Department funds the HSE which informed the previous Minister and, I presume, current Minister that it could not enforce consultants' contracts and the position was farcical.

One of the principal problems at the heart of all of this was the decision in 2014 to redesignate all beds in public hospitals for private care. This resulted in a profound shift and created a perverse incentive at the heart of the public health system to treat private patients in public beds. We must quickly address the issue of contract enforcement.

I do not believe the HSE can do this because it is caught with a perverse incentive. It has to fund the hospitals and it does that by putting public patients on waiting lists and private patients in public beds. Whoever carried out the review for the Minister did not get to the heart of the problem because public waiting lists are increasing and some consultants do their private work elsewhere while junior doctors oversee their public waiting lists. The Department of Health seems to be incapable of enforcing it. What is it doing about it? The HSE is in a bind with stretched budgets. The fact that many public hospitals have a huge revenue stream from treating private patients ahead of public patients will not address the issues we are discussing, to ensure people are dealt with on the basis of clinical need.

"Prime Time" last night showed a Mrs. Comber, a patient in Limerick, trying to get a cataract operation. I watched the programme a second time because I thought I was seeing things initially. A Deputy from West Cork is busing people to Belfast because they cannot get into Cork University Hospital for ophthalmic surgery. At the heart of our public health system is a system that perversely incentivises public hospitals to put public patients on waiting lists and private patients in public beds. Many consultants are in on the game as well. I do not believe that either the organisation that Mr. Breslin oversees or the HSE is capable of enforcing these contracts because they are incentivising the public system by doing this. We need an independent evaluation and enforcement of contracts, separate from the Department of Health and HSE. The Health (Amendment) Act 2013 allowed for charging in all public beds for private patients.

At the heart of the Sláintecare report is the necessity for an impact study on the removal of private practice from public beds. I argued for that and I was delighted that it was included in the report because the committee believes that this is creating difficulties in the public health system. Equally, to strip it out in one fell swoop could have a negative impact, just as the present situation has a negative impact. We have to tread carefully to ensure we do not undermine services.

On fiscal smoothing of capital spend to comply with EU budgetary rules, there has been poor capital expenditure over the past ten years in the health service and there will be a huge deficit in the future with demographic changes, aging population, more chronic disease and chronic illness all placing more demands on our public health system. We will need to spend a lot of money on the capital side. The Economic and Social Research Institute, ESRI, said we need at least 2,000 extra beds. The Minister's capacity review will be coming out soon which will probably seek more than that because we need more than acute beds. Do we need to renegotiate with the European Union how we account for capital expenditure? Four years is too short for fiscal smoothing a hospital. In any other business that would be done over a prolonged period. The system is front-loaded and that will diminish the capacity of the State to invest in major infrastructural projects that are needed because of the deficit rules.

Has any thought been given to that issue that is retarding the State's capacity to invest in long-term capital spend? Have any additional resources been outlined or highlighted in the Department of Health to oversee this? I know there will be a recruitment process for a lead executive. There has to be a draft implementation plan. Have any senior officials been specifically designated to this particular project to make sure it is up and running? The process is being led at the most senior levels in the Departmentand the HSE and also involves close engagement with the Departments of the Taoiseach, Finance and Public Expenditure and Reform. The committee was considering this and felt at one point maybe it should be separate from the Department of Health because we can argue that the overseers may have other interests because of budgetary constraints and not wanting to bring political embarrassment to their masters and I do not mean any disrespect to the Minister or to Mr Breslin but I am referring to the system. Will the system bring forward reports and recommendations that the political masters simply cannot implement and are there difficulties and conflicts of interest there? What additional resources have been given to the Department of Health by way of personnel to start the process of implementing the reform outlined in the Sláintecare report?