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

I apologise for being late as I was trying to be in two places at the one time as I had to attend the Convention Centre for Leaders' Questions.

I have two sets of questions for the Minister. I apologise if they have been asked and I missed them.

I will step back from Covid and all the other issues in the health service at the moment and turn to the reform programme, and Sláintecare in particular. One of the key measures recommended in Sláintecare was the need to restructure the HSE and to move away from having seven hospital groups, nine community healthcare organisations, various other mental health teams and so on, which has resulted in a completely disjointed and non-accountable organisation. It is a big black hole. All the money goes in and we do not know where it goes. There is no legal responsibility for the provision of services or for budgets.

This was the issue that arose most often at meetings of the Committee on the Future of Healthcare, raised both by all the members and by all the witnesses who appeared before it. They said it was crazy and that there could not be integrated healthcare if different elements and sectors were all doing their own thing with no single budget. The idea of the restructuring that was agreed to at the committee was that there would be a regional structure, a single budget and a single management structure within each region, which would mean there would be accountability for the provision of services and the spending of money. That is essential.

This was also a significant element of the famous agreement with the IMO that we have all been talking about in recent days. The IMO signed up to the idea, which was a huge step forward, while across the board, in the main it has been accepted as something we absolutely have to do. This was announced at the end of last year or early this year and there was a commitment at a political level to getting it done. The then Minister, Deputy Harris, was very strong on it, yet it now seems to have been parked and put on hold. I urge the Minister, Deputy Donnelly, if he is serious about reform, to put that back on the table and to begin the discussions and the planning and so on. I appreciate that everything was difficult, and still is, but this needs to happen and there will not be reform unless it does.

In recent days, there has been much discussion of the article in Villagemagazine, and I will not get into that at this point. There was another article in the same edition about a concerning interaction between public officials within the health service and the HSE, and the private sector. That needs to be examined and to receive some response. It relates particularly to a proposal mooted in recent years for a private hospital in the Airside area of Swords. It was being promoted heavily with posters and so on by a Fine Gael candidate during the general election campaign earlier this year. I am just raising alarm bells about that. There were also various photographs with very senior people, including the then Taoiseach, at the launch of plans for the hospital, and that needs to be examined. There are big question marks over this. As long as this kind of stuff is going on in the background, with profit being a motive for many people and potentially within the public health service, we will never get serious reform. That is the kind of area that definitely needs to be reformed. It is why we as a country are an outlier in European terms. We are the only country in Europe where half the population have to pay every time they want to access healthcare. The Minister knows that access is the key and that money is a driving force for people. That needs to be removed.

I ask the Minister to consider that. I asked him some questions about it previously. If what is in the article I mentioned is true, it is a matter of serious concern. It will also work to stop any kind of serious reform taking place.