Simon Harris (Wicklow, Fine Gael) | Oireachtas source

No, the Senator did not do, as I already said. He asked why reform and transformation have not happened after 15 years. Having been three years in my current job, I want to give the Senator my perspective on that question. It has not happened because of a failure of collective political leadership and a failure to both make and stick with decisions on health. In fairness to people in this room, including the Chairman of this committee and others, the first time we did that was with Sláintecare. We can have the debate about whether setting up the HSE was a good or a bad idea or whether it should have been done differently but if we park that, over the past 15 years political parties, including my own, were talking about abolishing the HSE, about the Dutch model of healthcare, about going back to the old health board system and so on. There has not been a certainty of policy direction in relation to health care for a generation, up until now.

People ridicule new politics and minority Governments and sometimes I share the frustration with new politics but one of the good things that has come out of the lifetime of this Oireachtas is the fact that on a cross-party basis, we have an agreed policy direction for health. This means that when I am no longer Minister for Health and Fine Gael is back in government after the election with a new Minister or whatever else might happen with an election, we will still have a clear plan with which all the parties agree with the exception of People Before Profit and Solidarity. Everybody in this room agrees with the direction, which means that the people sitting to my right, all the people they represent and all the people who work to them now have a clear policy direction. I believe that for the first time in a generation, we have a chance to crack this. What we are not going to do is what we have done far too many times, namely, start a bit of reform, change a Minister, have another bit of a different reform plan and go off in that direction. We have a clear reform plan to which we have all signed up. We have all said that regardless of politics, the name of the Minister or who is in government, this is what we are doing, which is a massive opportunity and prize for the health service and, most importantly, for the people of our country.

Regarding what is and is not in my opening statement, as members can imagine, when one is Minister for Health, one can only touch on so many issues in an opening statement or I would still be delivering it. Disability was mentioned on page four of my opening statement with regard to the extra 100 therapy posts to help deliver access to services for people with disabilities but I take the broader point made by Senator Dolan. He asked a very important question, namely, how disabled people or any of us read a letter issued by the director general or me or a comment made by any of us regarding fiscal prudence and living within budgets. What I would say to those people is that I hope and believe they should read the letter this way because that is the way it is intended. The opportunity cost to service users - to citizens - of a budget overrun is significant. Again, I am not apportioning blame but imagine if we had a situation where we did not have to find €600 million for an overrun. Imagine what, as a country or as a health service, we could have done with that money. What the director general is correctly doing is saying to everybody, and I know he said it in his opening statement, that if we can make a real push here and a real collective effort to deliver services but remain within budget, it means that the extra investment we will inevitably receive in budget 2020 can actually deliver more services and begin to address some of that unmet need referenced by the Senator.

Senator Dolan referenced Rehab, the broader sector and the implications for that. The first thing I want to say is that the Minister of State, Deputy Finian McGrath, co-chaired three meetings on this. This was a very intensive process that is ongoing. There is still intensive ongoing engagement. We continue to engage with sectors. We do not just have a conversation. Our priority was service users and making sure services continued to be delivered. It is not a case of "come on over and receive additional funding". That is not the case. The case is that if there was an acute pressure that would have damaged services or detrimentally affected service users, we wanted to work constructively together to try to address that. The broader issue of the section 38 or section 39 bodies will require a forum, process or engagement. The report by Dr. Catherine Day has been quite instructive and helpful in that regard. That is a matter for the Minister of State, Deputy Finian McGrath, who will comment on that. There needs to be a conversation about the voluntary sector and the public health service, how they interact, mutual respect, clear understanding of roles and a clear understanding of funding. I might ask the director general to comment.