Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I would be happy to discuss that with Deputies Murphy O'Mahony and Kelly.

A population-based approach ensures we design the structures based on where our population is, rather than designing the structures and then hoping the population finds or makes its way to them. We will look at a map of Ireland not just in a geographical sense but in terms of where our citizens live and what needs they have. Ms Magahy spoke passionately about citizen engagement and empowerment. What do the citizens of Deputy Murphy O'Mahony's region or my region want their health service to look like? We need to develop the structures around that, rather than continuing, as we have often done in healthcare, to put up the structures and then tell patients to come and access them.

On why new structures are not yet in place, that is a valid question and one that many people at home are also asking. The Deputy made the point that Sláintecare is above party politics, which is exactly the answer. The risk is that if I, as the current Minister, or another Minister before or after me, tinkers with and starts changing the structures, they then become the structures of this or that Minister and often do not last the test of time. There has been far too much chopping and changing in health, and all of us in the political system are collectively guilty of not allowing the health service to properly bed in to a programme of reform. The beauty of and difference with this programme is that while I, as the incumbent, will implement it, in all likelihood those who come after me will also have signed up to it. This means there is a good chance it will be done and will stand the test of time.

On community care, we have made progress on some of the issues. We have given a commitment, for example, to a statutory home care scheme. I know the Deputy has a strong view that, as politicians, we say we want everyone to be able to grow old at home in his or her own community with dignity but the only statutory scheme we currently have is the fair deal for nursing home care. Home care around the country is variable in its delivery. The idea that there would be a statutory home care scheme is one example of the community care. The model we need to roll out for our nurse practitioners and the general practitioner contract is still ongoing.

What do we mean by "those who need it most"? The authors of Sláintecare, many of whom are here today, are trying to move away from a position where the ability to pay trumps medical need. This is a move with which I agree. We want to ultimately have a system where nobody lies awake in bed at night wondering if he or she has the money to access healthcare the next day.