Catherine Murphy (Kildare North, Independent)

I thank the United Left Alliance for tabling the motion. The Government terms the health care service it intends to build as fair care. It is difficult to visualise what in fact the Minister has in mind. I accept we must build a health care system that gives us the best possible care that is affordable. I do not think any of us would dispute that, but I do not get any sense that this is what is occurring.

It seems that the Department of Finance is running the health service or the mandarins with the financial purse strings in the Health Service Executive. Many of our institutions - educational, health and local government - were largely constructed in the 19th century and we further fragmented and complicated them. It does not seem that we are capable of building the kind of institutional arrangements that are needed for our public services. It is not just about institutional arrangements but the principles under which those arrangements are in place, namely, equality of care and its delivery on the basis of need, and the question of social solidarity where people make a contribution so that everyone has the ability to receive fair services.

The health service is a mixture of voluntary hospitals, public hospitals, private hospitals and co-located hospitals. It is dysfunctional. The overarching dysfunction is complicated by the Health Service Executive, the design of which was flawed from the outset. It does not function for those who work within the system and it certainly does not function for those who require services. There is no doubt that those who can afford to pay for private health care do so because they can expect better outcomes. Essentially, they purchase private health care largely because they are afraid of depending on the public system. When people get into the public system they get very good care but the problem is to get in.

The list of hospitals in the motion and the problems they face is not exhaustive but it gives a snapshot of what is going on. We need to see a map of hospital services nationally and the functions they perform, what hospitals are linked, how many beds are available and how that relates to the population. The census indicates we have a growing population. The greater Dublin area shows consistent growth. Demographics play a part in health care needs. We must see that kind of mapping of the health service.

We have been told that it will take more than one Dáil term to introduce the health care system but we need to have some sort of indication of what is intended and the sequence of what is intended. Currently, there is a reduction in spending and a reduction in staff. The closure of hospitals always has a knock-on effect on the hospitals to which they are linked. For example, when one closes the hospital in Navan, one puts pressure on Blanchardstown hospital. When Blanchardstown hospital is under pressure the Mater Hospital is under pressure. When the Mater Hospital is under pressure, Beaumont Hospital is under pressure. It is a linked system. We are told that when services in Navan are reduced, the other hospitals will pick up the slack if that is necessary, but at the same time one sees the budgets of those hospitals being reduced. It does not appear that a system is being put in place that will be able to deliver.

We talked to some nurses who were outside Leinster House some weeks ago. They begged us to go and look at what they face every day in accident and emergency services and wards. They are told to postpone appointments for people who choose elective surgery. One might not see that as being serious but having spoken to the nurses concerned, it appears serious. They are at the coalface trying to deliver a service in a difficult situation.

Beds are being closed in hospitals and people are being left on trolleys in the same hospitals. The Health Information and Quality Authority, HIQA, has indicated that the situation, for example, in Tallaght hospital was unsafe. There are knock-on problems in terms of infection control when one tries to shoehorn too many people into a small space. It cannot be described as anything other than a crisis.

The recruitment embargo is a crude instrument. Agency nurses are a much more expensive way of delivering health care but they are being used to fill gaps where there is inadequacy. The implementation of the changes is not targeted. That will be problematic when it comes to February when more people leave the system. Those who retire are often at the top end who have been in place for a long time. They are the most experienced and will be the most difficult to replace, in particular those who are on the front line. Adequate consideration has not been given to what will happen in that regard. The lack of step-down facilities is another concern.

I was interested to read something to which this country signed up in 2006. I refer to a TASC report, Eliminating Health Inequalities. It states on page 26 of the report that:

In 2006, the Irish government, together with its EU partners, agreed a statement of common values and principles that underpin EU health systems and provide the framework for an explicit statement of national health policy in this country. Following the decision to exclude healthcare from the scope of the Directive requiring competition in the provision of health services within the EU, the member states acknowledged that health systems are a central part of Europe's vision of social protection and make a major contribution to social cohesion, social justice and sustainable development.

In their statement, the European health Ministers pledged to protect the values of universality, equity, solidarity and access to good quality care. It is worth elaborating on what these values mean:

Universality - no one is denied access to medical care;

Equity - there is equal access according to need regardless of ability to pay;

Solidarity - the cost of medical care and health systems is borne fairly across society and in such a way that accessibility to all is guaranteed;

Access to good quality care - medical care is safe, of a high quality and responsive to patients' needs.

I know the world has changed dramatically since 2006. The Lisbon treaty enshrines the Charter of Fundamental Rights. We had two Lisbon treaties. After the financial crash, people came to Ireland to tell us we needed to sign up to the Lisbon treaty. What does the treaty say about health care? It says:

Everyone has the right of access to preventive health care and the right to benefit from medical treatment under the conditions established by national laws and practices. A high level of human health protection shall be ensured in the definition and implementation of all Union policies and activities.

We hear nothing now from the European Union about solidarity or the Charter of Human Rights. We hear only about financial matters. We must get back to the point where solidarity, equality and people mean something. We must put Europe under pressure to deliver on this matters.

There is a direct relationship between the €700 that will be transferred to Anglo Irish Bank in the next week and what is happening in the health services. It is astonishing that tens of thousands of people are not out on the street, given what is happening at present. This is a crisis and it needs to be faced up to.

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