Joan Collins (Dublin South Central, Independent) | Oireachtas source

I do not want to go over old ground, but we know that we have a very dysfunctional health system. The NHS in Britain was set up by Aneurin Bevan and there was a structure to which everybody worked. In Ireland the system was developed in a completely different way. We have section 38 and section 39 organisations, the involvement of the religious in health care, private GP services and so forth. The Sláintecare plan is very significant because, as the Minister has pointed out, it provides a roadmap for us. Everything one discusses, no matter where someone is in the health system, will be guided by the plan. It is radical and one that I support because it will move us towards a single-tier, universal health service paid for from general taxation. However, I am concerned because the report was laid before the Dáil on 21 May and we were supposed to have quarterly reports on the implementation of the plan, which means that we should have received such a report in September. We had a debate on the report which began in the Dáil on 22 June and only finished last week. We have had a very poor response from the main political parties. There has been only one speaker from Fine Gael and two from Fianna Fáil. That is an indicator of a lack of interest, which gives cause for concern.

The real driver of the programme is the setting up of the implementation office and the appointment of an implementation officer at Secretary General level. That should have been done by July. While I accept that delays can happen, progress is very slow. The Minister has said that in July the Government agreed to move forward with the establishment of a dedicated programme office and to recruit a lead executive, but we are still waiting for that to happen. We recommended that the office be located within the Taoiseach's Department. The Minister made reference to the technicalities involved and said it would be located within the HSE. However, if there is resistance, that is from where it will come. Locating the office in the Department of the Taoiseach was recommended in order that it could be kept separate. The idea was that the lead executive would have authority to implement the plan.

The Minister has said he has also been tasked with developing a response and a draft implementation plan for consideration by the Government by the end of the year. The committee did not ask the Minister to do this. We asked that the implementation office do so, in co-operation with the Department. That is why it was so important that the implementation office would be in place as quickly as possible in order to direct progress. The issue of private practice in public hospitals, for example, should have been dealt with by the implementation office, in conjunction with the Departments of Health and Finance. The implementation office will be the driving force and unless it is put in place, implementation of the plan will be left up to the Minister, which should not be the case.

The Minister has said €1 million has been set aside for the implementation office, but we wanted much more to drive it forward. We wanted someone to take the Sláintecare report and figure out how to get a buy-in by staff, the general public and all of the political parties. There have been countless reports produced on the health service. It has been pointed out that 2,000 administrative and managerial staff were recruited between 2014 and 2017, but only 39 public health nurses were recruited in the same period. That is what the implementation office is supposed to address. If there are proposals to recruit new public health nurses, we must go into the schools to encourage young people to consider working in the health service. We need to tell them that it will be vibrant, not the service that is in place, that in the future those who will work in it will enjoy their work. We need to improve communications between staff - nurses, doctors, GPs, psychiatrists and so forth. Unless there is a vision driven by an implementation office that will be absolutely determined to achieve the Sláintecare reports goals and that will work with all groups of stakeholders, we will not succeed. The implementation office will not be able to cover every dot and comma, but it can work with the groups affected and convince them that if they work with it, there will be change. However, it must be funded properly to enable that to happen. Allocation of the €600 million required for the Sláintecare plan has not been committed to in the 2018 budget.

There are many things about which I am concerned and unhappy.

Unless there is urgency in addressing these concerns, the people in the background who do not want them to be addressed will just keep picking away and undermining the process and we will not have a health service of which the people can be proud and in which they can proudly work.