Oireachtas Joint and Select Committees

Wednesday, 4 December 2019

Select Committee on Health

Estimates for Public Services 2019
Vote 38 - Health (Supplementary)

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael) | Oireachtas source

I wish to repeat the point that the normal procedure in a debate of this nature is for discussions to alternate between Government and Opposition. Otherwise there is no sense in some of the rest of us coming in until the Opposition is finished. I could come back tomorrow. If the Chair gives me notice I will be quite happy to do that.

I want to draw attention to some of the fallacies in my colleague's remarks. We have had a long debate about various new medicines becoming available. There has been a strong debate in the House and outside of it, and we all know the demands that have been made in the course of the last year. They are legitimate demands. We have to listen to them and take them on board. We also have to take on board the concerns of the patients and families who depend on these innovative medicines and are hoping for a reimbursement programme. There is no sense in coming here at the end of the year and asking what all that was about, where it came from and what has gone wrong because we did not think about it before. That is not acceptable behaviour at all. This is nonsensical stuff. We are having a debate that we should not have at all. It is a waste of time. We are returning to every item of expenditure on the basis that the children's hospital overrun is causing all the problems. It is not. If people had followed the debate that has taken place in this country in the past three years they would not have to ask those questions. It is misleading to the general public to pretend that this is the answer to all their prayers. If people want to say that we should not continue with the new children's hospital, by all means let them say it. Let them embrace that ideology. Let them come forward with it. That puts an end to the debates. They can then spend all the money that was going to be spent on the children's hospital elsewhere, provided, of course, that it meets the criteria. However, fantasising in the committee or in the House about where money should be spent after it has been spent is a waste of time, energy and resources.

The Irish Fiscal Advisory Council has opined on this issue. That is correct. I have listened to its opinions repeatedly. The council has a job to do and I fully respect the need to stay within budget insofar as it is possible. I suggest its officials should go to the hospitals and ask the patients on waiting lists and their families what should be done in respect of A, B, C or D as it affects them. It is about time that we copped ourselves on. We must get away from repeating colourful nonsense in the media. I am not interested in that sort of thing. I want to see something done directly about the subject in question. There is a flaw in the system. We need to identify a contingency sum in the health Estimates on an annual basis, one that is sufficient to meet the projected overrun in demand.

I note the figures for 2012, 2013 and 2014 as compared with 2007. There was a vast difference in circumstances. The country was broke in 2007 and it was very easy to come up with an Estimate that fell within the required levels, even though achieving that level left the country even more broke. We have a situation now where we have to anticipate the growth in demand facing the system. The health service is a demand-led service. We have to make up our minds in this committee, in the House and in the debate nationally. What do we want to do about it? Do we intend to make a cool, calm and collected decision about what is required to run the services at the beginning of the year, given the number of imponderables likely to come before us? The Chair has spoken about this, as we all have. We need to cut out the pretence and actually identify it. I believe that we should be budgeting for a higher level of excess expenditure, for want of a better description, in order to cater for the continuity of the services throughout the year.

There are two groups of people who can deal with that. They are the managers of the system and the economists of the system. There are those who will say that over the years economists have strangled the health services, that their activity and inactivity in other areas have caused problems for the patients and the general population. We have to deal with that. We have to establish the level of growth. To put that in context, members should think of the number of people who left the country in the period from 2005 to 2014. In the latter part of that period there was no money in the country to pay for anything. We must compare like with like. It is utterly outlandish for any spokesperson for any party, Government or Opposition, to pretend that if we curtailed expenditure on the children's hospital we would somehow solve all our problems. We would not. We have a budgetary problem that needs to be addressed. The current budgetary problem is the annual budget for a Department. This is one of those Departments. It is the one Department where outlay is determined by demand. We either meet the demand or we do not. I ask that we confine ourselves to those areas, because they are important.

I wish to mention another area that comes to mind. I will address these points collectively. I will not go through them individually. I read them insofar as I could and I had the same difficulty. I was travelling yesterday and I did not get the chance to read them. I must say this.

The mental health services are still the Cinderella of the system. For example, it is impossible to get treatment for a child who is in need of a programme in any service at the current time. It cannot be done. People are admitted to the accident and emergency departments of general hospitals and spend the whole day there, but there is nowhere to go. There are no beds and no permanent programmes. There are permanent programmes in place to deal with drug addiction and other health matters, but there are no programmes for mental health patients, especially children, who require attention of an ongoing nature as well as treatment and care under supervision outside and inside of a family setting.

In the course of the preparation of the Estimates, I ask the Minister to outline to what extent attention was given to that area. It needs attention. I know of a child who was waiting for 12, 14, 18 or 20 hours on a trolley in an adult hospital, having been diagnosed four years ago as being in need of urgent attention and a programme. The child has failed to get access to a programme from any agency, such as Linn Dara, St. John of God's and so on, for a variety of reasons. However, it all comes down to one thing, namely, the availability of a necessary framework and structure to accommodate that patient.

Can we be assured that there is something to deal with that within the Estimates this year? Whatever happened before was not sufficient.

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