Jan O'Sullivan (Limerick East, Labour)

It is important that we have this debate today, although we will need to return to it in the context of a budget in early April. The background to the significant health cuts is the failure of the Government to handle the economy, going rapidly from boom to bust, and giving rise to a situation where there will be severe health cuts that will cause pain and take a long time to recover from. If the proposals in the media come to pass, we will see huge levels of distress in many communities.

The Minister has rightly pointed out that we increased funding in health over a number of years but the problem is that we did not reform the sector over those years. There will now be drastic cuts to a health service that, despite the rhetoric of the Minister, has not been reformed. When the HSE was established, its layers of management were not removed and the HSE is now cutting across the board, which will have an undoubted impact on front line services.

It is not a reformed service because the improvements that would have made it more lean and efficient have not happened. The Minister has talked about it many times but she has done nothing about it. Money is still being allocated throughout the system without being related to outcomes in any way and that is the problem. We have models of good practice but they have not been implemented so we do not have the practices that would ensure that money is well spent.

We have a relatively high percentage of total spending going on health — 25% according to the Minister, 11% of national income and up to 13.5% if we include private money. That is what the US is spending but the outcomes are just as bad there, despite the high level of income spent on health.

The amount of money being spent on health is not the issue, however. The issue is spending the money well. Deputy Reilly has suggested ways in which money could be better spent. I also have suggestions that are preferable to slashing across the board, closing beds, cutting public services, reducing the progress planned for community services or even closing hospitals. My colleague, Deputy Sherlock, will refer to closures but there have been suggestions that the board of the HSE has considered closing hospitals, not just reconfiguring them in the manner that has seen services in the north east drastically damaged and services in the mid-west about to be drastically damaged. The promised cuts in the various reports will be made but none of the benefits, where increased money was supposed to be spent for services such as day care treatment and building up of central hospitals, will be provided.

The report for the south has not yet been published because all these things are taking place behind closed doors. People do not know what is happening. That is a symptom of what is going on — these drastic cuts are being made and although the Minister puts up a good front, people are terrified.

I was talking to representatives of Age Action earlier and they are receiving telephone calls from people saying there is a limit on the budget for the fair deal scheme; it is resource capped. People are scared that care of the elderly will get much worse because even if they qualify for a place in a nursing home, the money might be gone. All of this is taking place behind closed doors. I strongly support the sentiments of Rebecca O'Malley, the patient advocate, who stated that any proposed cut should be transparent, we should be told what it is and the savings involved, and it should be debated.

There have been cuts of €6 million in Crumlin Hospital, €12 million in Tallaght Hospital and St. James's Hospital and €11 million in Beaumont Hospital, with similar proposals throughout the country. Beds will be closed and there will be longer waiting lists. Undoubtedly, patients will be on trolleys in corridors waiting for services. The minor progress made in the past few years will be reversed.

I will not stand over cutbacks in services that will hurt patients. There must be a bottom line below which services will not go. We must ring-fence funding for development, for projects for Travellers, such those mentioned in the presentation by Pavee Point, the mental health budget, palliative care, disability budgets and, particularly, child and adolescent mental health, which was to see service developments that have now been put on the long finger. We must also have money spent on colon cancer screening proposals to ensure that programme is introduced in the coming years. There is a specific commitment to establish it this year and I want the Minister to give an undertaking that it will be forthcoming. The HPV vaccine should undoubtedly be reinstated for September 2009 because of its capacity to save lives in future.

We must get our priorities right because there is still wastage in the system. There is no reason that spare administrative staff could not be transferred to HIQA to do inspections instead of charging for them, something which is of great concern to the elderly. There is no reason, as Deputy Quinn just said, that if there is a shortage of staff in the Department of Education and Science and too many staff in the Department of Health and Children, because numbers have only been slightly reduced since the HSE was set up with all of its bureaucracy, those staff should not be transferred to do that work.

I propose that the NTPF be scrapped instead of closing beds in public hospitals. The Minister has introduced measures because she believes in privatisation and the private sector providing health care. The Labour Party does not believe in that and the majority of the public does not believe that is how the health services should be provided. The National Treatment Purchase Fund is a middle-man for private health care to make money out of the public system. If we still had a lot of money, we might say that it shortens waiting times for some people but if we are cutting the budget for public hospitals, we should get rid of the NTPF and save the money, around €100 million per year.

The consultants should be told that the increase agreed with them is to be deferred. The Minister is cutting funds to other health care providers through the legislation we passed last week so I do not see why consultants should not be asked to implement the new working arrangements, which I agree with, but to defer the payment. What they get is a multiple of salaries for consultants in other European countries. Starting salaries are three times those of British consultants and the OECD pointed out in its review of public services last year that, even before the higher wages were agreed, their incomes were 50% higher than in France and 80% higher than in Germany.

The Labour Party strongly advocates the scrapping of the co-located hospital proposal, which would save €1.3 billion over seven years. It was supposed to produce 1,000 beds but four years later it has not produced a single bed.

There is room for general efficiencies. Following the publication of the 2009 service plan, €530 million must be cut before the €480 million shortfall mentioned by the Minister is even taken into account. That is a huge challenge. The use of information technology, however, offers the opportunity for efficiency. I spoke recently to a man who wanted to pay by credit card in the accident and emergency department but he was told he could not because a bill had to be sent to him. This caused a raft of paper work when he was quite willing to pay on the spot.

The Department of Social and Family Affairs automatically gets money in times of high unemployment. I do not know why the Department of Health and Children does not also get money concerning its loss of income because of the loss of jobs from the levy and medical cards.

I look forward to returning to this topic again because it is such a vital service for people. There is much fear among the public over what is happening to health services, so we must find better ways of saving money than the ones that have already been proposed.

See this speech in context