Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I thank the witnesses for their presentation. It is clear that a great deal of work has been done on the detailed planning for the implementation of Sláintecare and the outworking of many aspects of the recommendations. That is commendable.

The missing piece is the funding required to make these recommendations happen in the short term as opposed to stretching out over future years, so we get beyond the point of pilot projects and individual funds for interesting things. They are not on a sufficient scale to achieve the type of step change that is required and was envisaged in the Sláintecare report. It is regrettable. The opportunity arose in the budget for the Government and those who support it to allocate the necessary funds at a level that would achieve that step change and ensure that citizens would see an appreciable improvement in services. That can only happen if funding is provided on the scale to achieve those major changes and the shifts in where we provide services. It is only when that happens that people will starting seeing a difference and will be able to achieve access.

The main problem for many of our citizens is that access is so poor. An example of that are the issues of eligibility and entitlement, on which the committee was very strong. We need to move beyond the current arrangement where people are eligible to receive services if the services are available but there is no legal entitlement. That is the big difference between healthcare and, for example, social welfare. I can appreciate that the witnesses are in an awkward position and that they must talk about the issue of entitlement potentially being kicked to a citizens' assembly, but the Sláintecare report referred to extending legal entitlement from the start of the implementation of Sláintecare.

There are other big ticket items that must be dealt with and where there has not been much progress. One of those is the consultant contract. Earlier Dr. de Buitléir spoke to the committee about its importance if we are to achieve the ending of private care in public hospitals, which is a key enabler and potentially a game changer in how we provide healthcare services. Will Mr. Sullivan give us any hope that work is being done on a new consultant contract? It was not referred to in the presentation. This is in light of the recommendations in the de Buitléir report, the issues that were raised during the summer regarding the Medical Council, a high level of bullying and unacceptable practices in the hospital doctors arena, the question of specialisation, and the fact that we seem to be concentrating too much on specialisation among hospital doctors at the expense of generalists and getting people out and working more quickly. There are indications that there is much interest in public-only contracts. We must move quickly towards those if we are to achieve significant changes in hospital services. Perhaps Mr. Sullivan will tell us the position with the new consultant contract and when we might see some product from that.

Equally, there is the GP contract. We know there is a major shortage of GPs and we know that many new graduates would willingly stay here if they could afford to do so and if they were not expected to set up their own practice or work as an assistant. There is a programme for Government commitment with regard to the introduction of salaried GPs. Is anything happening on that? There is a new GP contract, but as far as I can see there has been no progress on salaried GPs.

There are other areas on which I have questions.

One of the key recommendations of the Sláintecare report that was not covered in the report before us relates to legislation. If memory serves me, we recommended that legislation be introduced in seven areas. One of the most important is the question of accountability, throughout the system, starting with ministerial accountability for the provision of adequate services. It was recommended to us on the committee that introducing such accountability would be a game changer in respect of the politics of the issue. What is the status of that proposal and of the recommendation on legislating for accountability at clinical and administrative level? The chair of the board, Dr. Tom Keane, was very strong on the need to legislate for clinical accountability. As far as I recall, he stated it was one of the most important steps we could take. Given that our guests have not mentioned legislation, they might comment on that.

On the question of entitlement, is putting it to a citizens' assembly the only recommendation? We expected progress to be made in the area. I get the distinct impression the matter is being kicked into a long process. When is there likely to be some progress in the area?

On the additional 1,000 community staff who were flagged in the budget, I very much welcome the decision in principle but I am anxious to hear the planned timescale. If those who have control of budgetary matters had provided the funding in a more upfront manner, the staff would be recruited upfront, rather than in what has been described as the medium or longer term. To what extent has Ms Magahy's office control over the allocation of those staff posts? What is the basis on which it will allocate those posts? We in the committee were strong about having objective resource allocation systems in place and removing the politics from the allocation of resources. Will Ms Magahy update us in that regard?