Clare Daly (Dublin North, Socialist Party)

This is an important topic. Given the title Health Service Plan 2012, one might think this is a great step forward and strategic advance to reform the health service, but it is patently obvious on any reading of it that is not the case and underneath inoffensive sounding words such as "amalgamation", "synergies", "cost efficiencies" and so on the reality is that this is a continuation of the butchering and decimation of the health service.

The document does not hide that. The so-called plan will clearly have a major impact on front line services. We have to consider the points made by the Minister, Deputy Reilly, when he was in opposition. He said: "It is outrageous for the Minister or the HSE to suggest that there will be any improvement in capacity or service quality in light of the cutbacks that have already been implemented and the further cutbacks to come." The same man, in his ministerial robes, is doing exactly that. He is making cuts to cuts that he is on record as opposing and is making the situation worse. It is a real problem for hospitals and service providers.

Things were pared back to the bone and now the bone is being eaten away. When we talk about a reduction of 4.4%, we have to consider it in the context of the cut's that have been made and the deficits being carried forward by many hospitals which already could not cope. In that sense the cutbacks are more like a doubling of the figure. We completely reject the inference that the health service is bloated and that there is a fundamental problem.

The health service has already lost almost 9,000 employees since 2007. We are not talking about bloated fat cats at managerial level losing their jobs. In the Minister's plan, 1,600 nurses will exit the system, compared to 200 administrative staff. I am not saying the administrative staff do not deserve to keep their jobs but where is the serious analysis? Many hospital consultants are already on the record as saying that people will die as a result of these measures and cutbacks. To listen to the Minister speak on the Private Members' debate yesterday about how we will deliver better services with fewer employees was nonsense. No squaring of any circle could be completed.

When the document refers to activity levels falling by 6%, what the Minister is really talking about is longer waiting lists and people being kicked to touch. It is not a solution, it is a kind of cover-up. It is the same mentality that says the numbers on trolleys can be reduced if people are taken out of accident and emergency wards and moved to different corridors, which means they do not count in the figures.

While this is happening in the centre of the health service, home supports are being cut back. The document refers to a 4.5% cut in home support hours. When that is aligned with the chronic difficulties people have in accessing carer's allowance, one can see it will result in the worst of all worlds. There is a slash and burn policy across the board.

Everybody knows there is a crisis in the health service. Rather than taking the opportunity to develop and review our approach, we are being served up a diet of more of the same. It has often been said that we can judge a society by the way it treats its most vulnerable, elderly and sick. If that is the case this Government would face indictment for crimes in that regard.

The situation that is unfolding with regard to care for the elderly is disgraceful. Like all aspects of health service, it is not that we are not spending enough money, rather it is that huge amounts of money are being siphoned off into the private sector and private medicine in an unfair and unequitable situation that sees those who need care most being penalised. It is scandalous. This Government should be ashamed of the situation facing nursing homes.

Hardly anybody was in private nursing home care 20 years ago in Ireland. We now have a situation where two out of every three elderly people in nursing homes are in the private sector. The Government wants to further that trend by axing another 1,000 beds from the public nursing home sector. It is a ridiculous situation. We have seen figures bandied about to the effect that the private sector is much more efficient and it only costs €850 a week to keep somebody in a nursing home. Public nursing homes can cost anything from €1300 to €1800 a week.

Those flippant figures have been categorically exposed by the Ombudsman. Like with like is not being compared. The service provided by public nursing homes is far more comprehensive whereas the private sector cherry picks people and turns away those with high dependency needs because they are not profitable. The fact that the Government stands over a situation where there are no minimum staffing requirements in nursing homes is a disgrace. Private nursing homes can recruit fewer of the more highly skilled, higher paid nursing staff and have more low paid carers, which benefits them financially. It is scandalous.

The level of service being given to elderly people is far more comprehensive. The Minister should answer on some of these points. Why are we going in that direction? Let us look at what is provided. The Crooksling nursing home in Brittas has the highest number of high-level dependency patients. Some 84% of the elderly residents in the Minister's constituency require the maximum level of care. Medical staff in Tallaght Hospital would say the alternative for such people would be a hospital, such is the level of care they need.

They are getting excellent care in the facility and the Minister will say it will not be closed. The residents in the area know full well that is a lie. People are positioning themselves strategically to continue to undermine the facility by ordering Tallaght Hospital not to refer patients to the nursing home in order that a situation can be orchestrated whereby as the current elderly patients exit the system nobody will be there to replace them. It will make it look like the facility is more expensive and it will be shut down. Meanwhile, private nursing homes which have been given massive tax breaks and subsidies by the Irish taxpayer, which are operated by the likes of Dermot Desmond and friends, earn millions in profits. It is a crazy situation. The net result is not only the lining of the pockets of private individuals and reduced care for citizens; it is also causing problems for hospitals. Since Tallaght hospital, for example, cannot refer patients to Crooksling, it must accommodate 22 maximum-dependency patients who really should be in the nursing home. The Government will not let them go there. This is more of the same.

While many people celebrated the ring-fencing of the €35 million for mental health services, it is quite clear that there has been a cut in this area. We all acknowledge that, with the extra strain and stress of the current economic crisis, any failure to increase the budget for mental health services represents a cut because a considerable number of citizens need to gain access to those services. This needs to be attended to very carefully.

My last point is on private health care. We need a single-tier public health service. Many citizens can no longer afford private health insurance; some 47% of people have had it. The only reason people have private health cover is because they do not believe their families will receive adequate care without using it to jump the queue or enter the system. The system is completely wrong. We should use our tax system to have a proper publicly funded health service, and we should not give moneys to private insurance companies or adopt the Dutch model, which has cost citizens a considerable sum of money over the years. Our health service is excellent when people get into it but we are not joining the dots, however. A significant aspect of the ongoing problem is the lack of adequate investment at public level. The Minister is missing a valuable opportunity to use this debate to transform circumstances. In reality, he is doing exactly what he criticised his predecessor for doing; he is cutting further into the bone.

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