Brian Stanley (Laois-Offaly, Sinn Fein) | Oireachtas source

The Deputy has gone well over time, so I might tie in a related question of my own for everyone’s benefit. I mentioned dental services earlier. We understand that Mr. Moloney’s Department is not going to deal with the minutiae of the interactions between the Department of Health and the HSE. Nevertheless, it sanctions the large health budget every year for both organisations. Between now and whenever that budget is sanctioned, will Mr. Moloney ask them that specific question? We in the committee may disagree on many other issues, between the Government and the Opposition, but not on Sláintecare. If public health nurses are not provided and if the complement is not increased, the point Deputy Burke articulated well will be a problem.

The case I referred to related to dental services. There is no public dental service system at the moment. A contract that had been won with private dentists collapsed and, as far as I can ascertain, it has not been resurrected, in the midlands at least. Moreover, the school dental scheme is non-existent in most counties. In Laois and Offaly, it has not existed for a number of years and children are not seen in primary school or within the first three years of secondary school. Some of them leave school before any contact is made with their parents or anyone else about it. Children complete their junior certificate without having been seen by a public dentist. It has been a few years since I was in school, in the 1960s, but I recall being seen in third class.

Will Mr. Moloney ask the Department of Health why this is? I am raising this in a respectful way. We are trying to alert him to what is going on here. He will have to sign off on this budget, which I know he will do with good intentions, and we will approve it with good intentions in the House after debates and so on. We have highlighted just two examples. This is at the centre of Sláintecare. If there cannot be public dentists providing a school dental scheme, and if the point Deputy Burke made about public health nurses is not addressed, it will have a very significant impact on the delivery of Sláintecare. It is central. We are trying to keep people out of hospital. If we do not deal with oral health in children when they are young, there will be awful health outcomes, which is already the case, as doctors have told me, because oral health is not being dealt with. We are accumulating problems for child and adolescent mental health services for children on the autism spectrum because we are not reaching children in time. Similarly, if elderly and infirm people who live at home are not seen by public health nurses or if those nurses are not available to deal with their circumstances, they will end up in nursing homes or accident and emergency units. The system is just piling up. My understanding is that other countries look at the front-line services and start building them. I have attended meetings with representatives from the HSE at which - I am not kidding - your brain would turn into jelly after an hour.

You get all the management-speak and everything else but what you do not get is what they are doing to actually fill the gaps in public services.

We are trying to get Sláintecare. I understand Mr. Moloney cannot see everything that is going on. As any public representative will tell him, and I am saying this in a respectful way, the services at that end are just not there and it is so frustrating. We are held accountable by members of the public because they believe we can change things. As I said, we could fill an articulated truck with money on Kildare Street, drive it over to the Miesian Plaza, start offloading it with a forklift truck and put another €10 billion into the health service but, as things stand, it would not change matters because of how the system operates.

There are some people in the HSE trying to do good work. I meet and speak to them and they have shared their frustrations with me. The Department of Public Expenditure and Reform is the Department that signs off on expenditure. The Department of Health is the biggest spending Department. I believe its budget is bigger than that of the Department of Social Protection, or both Departments may spend around the same amount. With the Department of Social Protection, however, we can see where the funding is going. It is more straightforward. I understand health is complex and providing health services is complex. There is no perfect health system on the planet but some countries do it much better than we do. We are doing terrible for the amount of money we put into health. We are a developed country. We go around with our chests out saying how great we are doing, which is good, and that we are among the richest countries in the world. Why, 100 years on, can we not have a health system that provides a school dental scheme? That scheme has collapsed since the 1960s. There were always loads of public health nurses but there are not now, despite the increase in population. Before Mr. Moloney signs off on the budget for health, will he contact the Secretary General of the Department of Health – I am not sure if he has a direct line to the CEO of the HSE – and raise those two issues with him? I am asking him to do that as the new Secretary General.

I wish to revert for a moment to the Benefacts issue. Approximately €14 billion goes into the not-for-profit sector each year. The Benefacts database monitored that and provided information on it. It stopped because the Department of Public Expenditure and Reform was signing off on it, which meant that Department was central to the database being maintained. Despite other Departments and Accounting Officers not making a business case, is there not a business case for having that database? Less than €1 million - I believe it was €950,000 - was the biggest annual spend on it. That seems like a small amount of money relative to €14 billion. It seems that €1 million to allow politicians, journalists and, indeed, civil servants to have information at their fingertips from Benefacts is a relatively small amount. Forget about what everybody else says, including those who have said there is no business case. Does Mr. Moloney not think it would be good to have that database?