Billy Kelleher (Cork North Central, Fianna Fail)
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It reminded me a little bit of the charge of the Light Brigade at Balaclava whereby Lord Cardigan and his senior officers could be compared to the HSE being sent out to charge with inadequate resources and one inevitable outcome, namely, a budget deficit and a cutback in resources at the end of the year. In fairness, we must be honest with ourselves in terms of what can be achieved when it comes to budgets. Some of the service plans that were forced on the HSE - as opposed to being presented by it - in recent years were not achievable and inevitably we ended up with cutbacks at the end of every year.

I highlight these issues because they are important. In orthopaedics, for example, full surgical teams were on stand-by yet there were cancellations of all hip implant surgery due to there being no implants. That is the reality of what was happening in recent years. It was not Mr. O'Brien's fault or the fault of the HSE, it was due to a lack of planning and foresight. Sometimes the Department of Health is a bit like Lord Cardigan in blaming somebody else. We must be honest with ourselves. It is easy to consistently criticise the HSE and sap it of its capacity to deal with the challenges. We must be careful in that regard.

Deputy O'Reilly raised the issue of private patients in public beds. There is a perverse incentive at stake in that a hospital can now charge private patients in any public bed.

There is no doubt there is a perverse incentive for private patients to be treated in public hospitals because hospital management is under significant pressure with regard to budgets, and consultants will get paid by the private health insurance companies. If there was not, the Government would not have changed the legislation. It was changed for budgetary purposes which was quite evident at the time.

I remember listening to the speeches and the rationale behind it. It was changed for budgetary purposes to incentivise and encourage private patients to be treated in public beds. Prior to that, there was a 20% designation. At the same time as we have private patients being treated in public hospitals, we have public patients who cannot get into the public hospitals for treatment. There has to be a revaluation of that moral dilemma. Private patients should be treated in private hospitals, unless there is clinically no other way. The purpose of private health insurance is that private health patients go to private hospitals which, in turn, frees up capacity in the public hospital for public patients. At the very least, there should be an independent assessment of whether there has been a major increase in the volume of private patients going through public hospitals, thereby reducing capacity for public patients in public hospitals. I have many consultants, insurance companies and private health care providers informing me it is happening. And they are all wrong? It is a perverse incentive, as was outlined at the time during the change of policy in the Health (Amendment) Act.

The Minister referred to the bed capacity review as an important part of the planning process, looking over the horizon, taking into account demographics, changes in medical practice and all that flows from the modernisation of medical services. The other important issue in this context is workforce planning. This would have to be looked at in tandem. Otherwise, there is not much point in having a load of beds and no nurses or vice versa.

At one stage, there was a proposal to have a new grade called theatre assistant like they have in the United States and elsewhere. There was a lot of resistance to it, however. One of the major problems identified in the delays with scoliosis and other orthopaedic operations in Crumlin hospital and elsewhere was the lack of theatre nurses. Where are we with regard to the setting up of this new grade? Has it fallen by the wayside because of resistance or for other reasons?

With regard to waiting lists and accountability, the Minister referred to gynaecology and obstetrics in Cork and elsewhere. We have committed consultants and professionals across the health service, as well as committed administrators and management. At some stage, however, reasons have to be given as to why we have inordinate delays in some hospitals and not in others. It is important there is absolute transparency with regard to waiting lists across the whole of the Health Service Executive, HSE, including with consultants. The public is entitled to know that if one goes to X hospital, one will wait so long, while if one goes to Y, one will wait a different time. This allows comparisons to be done. With comparisons come competitiveness and accountability and all that flows from that.

This question is for Mr. Jim Breslin. The National Association for General Practitioners represents 1,600 GPs, while the IMO, Irish Medical Organisation, represents about two thirds, if not half, of that number. As it stands, the National Association for General Practitioners is outside the door while the IMO negotiates with the Department on the most important contractual discussions to take place in 40 odd years and which will set down the bedrock of health care delivery in the primary care setting. It is extraordinary the majority involved are not even sitting down to discuss the matter. Why is the Department speaking with the smaller organisation when it should be speaking with the larger one? It would be like going into Parliament to talk to the smallest parties as opposed to the largest party. It beggars belief.

We all hope that society will buy into the national children's hospital and it will be a beacon of a modern state, delivering modern care to the people we should cherish most. I hope every effort is made by the Minister, the Government and those charged with the responsibility of ensuring the national children's hospital is represented, that there is a voice for it, it is not delayed any further and it is not undermined by misinformation or a lack of information.

I met some of the parents of the children with scoliosis who are on waiting lists and I raised it in the Dáil in November 2016. The "Prime Time Investigates" programme touched everybody. One would have to have a heart of stone not to have been touched by it. Why is the system so inactive and cold to that call which was going on for a long time with regard to this particular issue? I accept there are many challenges to and draws on HSE resources. However, a system would want to be wholly inflexible and lack any compassion not to have responded to this matter in advance of the RTE programme. We need to be conscious of that. Delaying surgery for an inordinate period, which had a negative impact on people's health, did not rest easy with the public. It should not rest easy with a system which allowed it happen in the first place.

On the broader review of maternity and cardiac services, as well as broader services in general, when the capital programme is being assessed, are all the strategies underpinning the various deliveries of health care assessed first and then the capital plan put on top of that to ensure we have continuity of strategy? There have been concerns in the past, not just for the past six years, that there can be undue influence from a political perspective as to where capital spending should go when it should be based on what is required by the health services, as opposed to what is required by a political party or a Minister of the day.