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

I welcome all our guests. I think Deputy Durkan and I are the only two who were on the Committee on the Future of Healthcare, which addressed Sláintecare. I cast my mind back to those cross-party deliberations over an 11 month period with 14 Deputies. The issue that came up most frequently during those deliberations was the fact that the organisation of the HSE is disjointed and incoherent. At a time when we are supposed to have integrated care and integrated budgets, the HSE had seven hospital groups, nine community health organisations and God knows how many mental health teams and other structures. There was no coherence whatsoever. Members unanimously, as well as the vast majority of people who came in to give evidence, identified this as a key problem in how we deliver services. There are hospitals doing one thing and community services doing another, and never the twain shall meet.

There was a strong recommendation from that committee that we needed to co-ordinate all of that and restructure it with a regional structure so that we would have a number of regional organisations, perhaps six, that would include hospitals, community and all other health and social care services. There would be a single budget for each of those regions and a single management structure so that decisions could be taken on the spending of money in the best place. If it was more economical and effective to spend money on community services rather than expensive hospital services, then that money could be redirected, and there would be coherence and value for money. That was taken up, it was in the final report and it was accepted by Government, but I gather it has now been put on hold. That is really disappointing because that was a key recommendation. Unless we get that kind of coherence about the structure, the budget and the management accountability for the delivery of services and the spending of money on a regional basis, we are just going to continue with the HSE being amorphous, with nobody knowing who is in charge or where accountability lies. Is it the case that that has been put on hold and, if so, why? When are we likely to get back to implementing that key Sláintecare recommendation?

My second question relates to elective hospitals and Ms Magahy has responded to this to some extent. In the witnesses' consideration of that, are they considering the potential purchase of a private hospital, as happened in Edinburgh, to kickstart the shift to elective-only hospitals? I know the witnesses are in touch with Cappagh National Orthopaedic Hospital. There is plenty of space there and potential to develop it as an elective orthopaedic hospital. Is that on the cards?

My last question relates to the two key objectives of Sláintecare. One was to shift activity away from hospitals to the community so there would be better health outcomes and value for money. The other was to remove cost as an obstacle to people accessing care, because we are the only country in Europe where people have to pay the full amount to see a general practitioner, physiotherapist or such. Is there any funding in yesterday's budget to remove cost? It seems to have slipped down the agenda. We have not heard anything about better, cheaper access to GP care, community care or medicines. Can we expect anything out of the budget in that regard? Affordability is an important element of Sláintecare.